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Original article (non peer-reviewed)
Open Access
Abstract
Introduction Inappropriate use of antimicrobials
in hospitals contributes to antimicrobial resistance.
Antimicrobial stewardship (AMS) interventions aim to
improve antimicrobial prescribing, but they are often
resource and personnel intensive. Computerised decision
supportsystems (CDSSs) seem a promising tool to improve
antimicrobial prescribing but have been insufficiently
studied in clinical trials.
Methods and analysis The COMPuterized Antibiotic
Stewardship Study trial, is a publicly funded, open-label,
cluster randomised, controlled superiority trial which aims
to determine whether a multimodal CDSS intervention
integrated in the electronic health record (EHR) reduces
overall antibiotic exposure in adult patients hospitalised
in wards of two secondary and one tertiary care centre
in Switzerland compared with ‘standard-of-care’ AMS.
Twenty-four hospital wards will be randomised 1:1 to
either intervention or control, using a ‘pair-matching’
approach based on baseline antibiotic use, specialty and
centre. The intervention will consist of (1) decision support
for the choice of antimicrobial treatment and duration of
treatment for selected indications (based on indication
entry), (2) accountable justification for deviation from the
local guidelines (with regard to the choice of molecules
and duration), (3) alerts for self-guided re-evaluation of
treatment on calendar day 4 of antimicrobial therapy
and (4) monthly ward-level feedback of antimicrobial
prescribing indicators. The primary outcome will be the
difference in overall systemic antibiotic use measured in
days of therapy per admission based on administration
data recorded in the EHR over the whole intervention
period (12 months), taking into account clustering.
Secondary outcomes include qualitative and quantitative
antimicrobial use indicators, economic outcomes and
clinical, microbiological and patient safety indicators.
Ethics and dissemination Ethics approval was obtained
for all participating sites (Comission Cantonale d'Éthique
de la Recherche (CCER)2017–00454). The results of
the trial will be submitted for publication in a peerreviewed
journal. Further dissemination activities will
be presentations/posters at national and international
conferences.
Trial registration number NCT03120975; Pre-results.
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