Impact of a Regional Antimicrobial Stewardship on the Length of Stay of Patients Admitted to Hospital With Pneumonia

NCT ID: NCT02276092

Last Updated: 2020-01-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

1400 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-04-30

Study Completion Date

2017-04-30

Brief Summary

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This study evaluates the effectiveness of an antimicrobial stewardship program to reduce the length of stay of patients admitted to hospital with a diagnosis of pneumonia. The antimicrobial stewardship program will be implemented in several hospitals in Ontario, Canada. The program will identify patients with pneumonia, review their charts and make recommendations to their attending physicians about antibiotic management.

Detailed Description

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Antimicrobial stewardship is defined as any activity that promotes the appropriate selection, dosing, route and duration of antibiotic therapy. Antimicrobial stewardship programs usually include pharmacists and/or doctors with expertise in infection diseases management. Prospective chart review and physician feedback is a common intervention used by antimicrobial stewardship programs to improve antibiotic utilization and patient outcomes.

Pneumonia is the most common reason for antibiotic utilization in hospitals. Significant variation in antibiotic utilization for patients with pneumonia has been repeatedly demonstrated in published studies despite the existence of best-practice treatment guidelines. Treatment variation from these guidelines has been demonstrated to result in worse outcomes such as increased mortality. Antimicrobial stewardship programs can help reduce the treatment variation from guidelines.

Despite improvements in certain outcomes, antimicrobial stewardship programs have not demonstrated any impact on the length of stay of patients admitted to hospital with pneumonia. Part of this absence of evidence may be due to poor study design and failure to recruit sufficient patients. This study will include the implementation of an antimicrobial stewardship program across many hospitals and the study design and analysis will account for the design problems of the previous studies.

Conditions

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Pneumonia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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intervention

exposure to antimicrobial stewardship intervention

antimicrobial stewardship

Intervention Type OTHER

A member of the antimicrobial stewardship program will prospectively review the patient's medical record and make recommendations to the most responsible physician in the care of that patient

control

usual care with no exposure to antimicrobial stewardship

No interventions assigned to this group

Interventions

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antimicrobial stewardship

A member of the antimicrobial stewardship program will prospectively review the patient's medical record and make recommendations to the most responsible physician in the care of that patient

Intervention Type OTHER

Other Intervention Names

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prospective audit and feedback

Eligibility Criteria

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Inclusion Criteria

* Community-acquired pneumonia
* Immunocompetent
* Age \> 18 years

Exclusion Criteria

* Admitted to an intensive care unit or high intensity unit
* Requiring invasive or non-invasive ventilation
* Life expectancy less than 3 months
* Hospitalization within the previous 3 months for at least 48 consecutive hours
* Immunocompromised defined as defined as having leukemia, lymphoma, HIV with CD4 count \<=200, splenectomy or on cytotoxic chemotherapy
* Neutropenic \[defined as a PMN count\<=0.5x109 cells/L\] from any cause
* Receiving immunosuppressants \[defined as \>=40 mg prednisone daily (or steroid equivalent) for \>=2 weeks preceding hospitalization OR any other immunosuppressant used for systemic illness OR to prevent transplant rejection
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Royal Victoria Hospital, Canada

OTHER

Sponsor Role lead

Responsible Party

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Giulio DiDiodato

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Giulio DiDiodato, MD

Role: PRINCIPAL_INVESTIGATOR

Physician

Locations

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Royal Victoria Regional Health Centre

Barrie, Ontario, Canada

Site Status

Countries

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Canada

Other Identifiers

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RASP2013

Identifier Type: -

Identifier Source: org_study_id

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