Clinical trial NCT04798365: Antimicrobial Stewardship in UTIs in Nursing Homes
Official title: Implementation of an Antimicrobial Stewardship Program Targeting Residents With Urinary Tract Infections in Long-term Care Facilities
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Urinary Tract Infections
Keywords: UTI
antimicrobial stewardship
long term care facility
nursing home
Lead sponsor: Medical University of Graz
Sponsor class: OTHER
First posted: 2021-03-15
Enrollment: 326
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: Background: The widespread inappropriate use of antimicrobial substances drives resistance development at the individual and population level all over the world. In long-term care facilities (LTCF), antibiotics are among the most frequently prescribed medications. More than one third of antibiotics prescribed in LTCFs are for urinary tract infections (UTI). Studies have shown that 30 - 40% of antibiotic courses prescribed in LTCFs were unnecessary and that more than two-thirds were inappropriate based on society guidelines.

Preliminary data: A surveillance study on healthcare-associated UTIs at LTCFs of the Geriatric Health Centers Graz revealed that guideline recommendations on antimicrobial choice were met in only 50% of patients. The most frequently used antimicrobial substances for UTI were quinolones.

Aims: Using a multifaceted bundle of antimicrobial stewardship interventions consisting of clinical practice guidelines, care pathways and local as well as web-based education and training targeting nursing staff as well as physicians we aim to improve the quality of antimicrobial prescriptions for UTIs in four LTCFs in Graz, Austria.

Design: Non-randomized cluster controlled intervention study. Setting: The Geriatric Health Centers Graz are a local institution comprising among others 4 LTCFs (total of 400 beds). These will serve as intervention group. Four LTCFs located in the surroundings of Graz will serve as control group.

Intervention: The main components of the intervention are 1) two sessions of voluntary continuing medical education on the urinary tract infection program in each LTCF for physicians and nursing staff, 2) distribution of educations materials such as written guidelines on antibiotic prescribing including a smart phone friendly version, 3) implementation of the project homepage as a platform to distribute guidelines and educational videos and to enable physicians to ask questions which will be answered by an infectious disease physician.

Outcomes: The primary outcome will be the proportion of adequate prescriptions (adequate in terms of antimicrobial choice). Secondary outcomes include proportion of adequate prescriptions (adequate in terms of decision to treat), number of cases with clinical failure, number of admissions to hospital due to UTI, number of adverse events attributed to antimicrobial treatment for UTI, percentage of extended spectrum betalactamase (ESBL) producing enterobacteria isolated from urinary cultures


Eligibility criteria: Inclusion Criteria:

* residents living in the participating long term care facilities who experience urinary tract infections (UTI)

Exclusion Criteria:

* residents without UTI

Primary outcomes:
measure: proportion of adequate prescriptions (adequate in terms of antimicrobial choice)
timeFrame: 2 weeks
Secondary outcomes:
Other outcomes:
Locations:
city: Fehring
country: Austria
facility: Sonnenhof
city: Graz
country: Austria
facility: Geriatric Health Centres of the City of Graz
city: Graz
country: Austria
facility: Volkshilfe Steiermark
city: Voitsberg
country: Austria
facility: Bezirkspflege-und Seniorenheim Voitsberg
Study officials:
References: