Antimicrobial Stewardship Program and Ventilator Associated Pneumonia

Study Overview
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Brief Summary
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Antibiotic Stewardship Programs (ASPs) help clinicians improve the quality of patient care and improve patient safety through increased infection cure rates, reduced treatment failures; however, there are different techniques, with variable results, of its application including what is called ASPs bundle and there is a need to investigate the effectiveness of implementing a comprehensive care bundle program including the key components of ASPs and the key items of infection control measures, this program can be called Antimicrobial Stewardship Comprehensive Care Bundle Program (ASCCBP).

Detailed Description
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Survey experimental study will be done in the first 6 months as regard antimicrobial drugs pattern and organism's sensitivity and resistance pattern in VAP patients. In the next six months, clinical implementation of ASPs and infection control bundle will be applied on VAP patients. Then, in the later six months the investigators will study the outcome of VAP patients as regard: Amount of cost of antibiotics. Appropriates of antibiotic use (initiation, duration & time of discontinuation). Rate of resistance Clinical outcome, infection rate &length of stay. Regular reports on antibiotic use and resistance will be admitted to relevant staff every one month. Also, audit and feedback about resistance and optimal prescribing will be applied every one month for ICU stuff as an open discussion. The stewardship consulting team will include microbiologist with clinical experience in the field of antibiotic use and infection control. Stewardship team also will include the relevant ICU staff and an experienced clinical pharmacist.

Official Title
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Impact of Implementation of Antimicrobial Stewardship Comprehensive Care Bundle Program on Ventilator Associated Pneumonia in Surgical Intensive Care Unit

Conditions
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Ventilator Associated Pneumonia

Intervention / Treatment
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* Other: implementation of antimicrobial stewardship comprehensive care bundle program on ventilator associated pneumonia patients


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Patients, ≥18 years, who were intubated and mechanically ventilated for more than 48 hours in ICU and showing clinical criteria of VAP Exclusion Criteria: Patients on immunosuppressive drugs. Patient with chronic lung disease, chronic liver disease& chronic renal disease. Immunocompromised Patients. Patients intubated and mechanical ventilated outside the ICU before admission. Patients manifested clinically with picture suggestive of VAP but less than 48 hours on mechanical ventilation.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group A in preimplementation phase<br>Patient and antibiotic related data were collected to calculate and define; ventilator associated pneumonia incidence, mean ventilation days and mean length of stay, antibiotic selection, antibiotic cost, antibiotic susceptibility pattern, antibiotic consumption. | |
| Group B in postimplementation phase<br>The appropriateness of antibiotic use (selection, initiation, duration & time of discontinuation) before and after implementing the educational program was compared, calculation of the change in the ventilator associated pneumonia incidence & length of ICU stay, calculation of the change in the rate of antibiotic resistance and calculation of the cost change of antibiotics used after implementing the educational program. | Other: implementation of antimicrobial stewardship comprehensive care bundle program on ventilator associated pneumonia patients<br>* Construction of a comprehensive care bundle educational program. This program consisted of many elements: Antimicrobial stewardship programs, VAP bundles and infection control policy implementation and the investigators studied the impact of this program on: Antibiotics cost. Appropriates of antibiotic use (initiation, duration & time of discontinuation). Rate of resistance Clinical outcome, infection rate &length of stay.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in ventilator associated pneumonia incidence | After implementation of the Antimicrobial Stewardship Comprehensive Care Bundle Program (ASCCBP), the percentage of VAP incidence was measured to assess the effectiveness of the program. | 18 months | 
| change in antibiotic resistance pattern | measuring the change in sensitivity and resistance pattern of antibiotics used in ICU was done by assessing the change in the sputum culture and sensitivity results. | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ventilation days | Days of mechanical ventilation of each patient were measured to calculate the difference before and after implementation of the program. | 18 months | 
| antibiotic cost | costs of antibiotics by Egyptian pounds were calculated to assess the effectiveness of the program | 18 months |