Computerized Antibiotic Stewardship Study

NCT ID: NCT03120975

Last Updated: 2020-11-19

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

Clinical Phase

NA

Total Enrollment

16176 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-03

Study Completion Date

2020-03-31

Brief Summary

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Prescribing antibiotics frequently poses problems in practice, since patients don't always receive the right dosage of the right antibiotic for the right period of time. This promotes the emergence and spread of antibiotic resistance. The investigators of this trial aim to develop a system designed to help doctors to use antibiotics more appropriately. Under COMPASS (COMPuterized Antibiotic Stewardship Study), doctors in three Swiss hospitals will receive tips on the use of antibiotics that are integrated directly into electronic health record and will also be given regular feedback on their use of antibiotics. Parallel to this, data on the antimicrobial prescription practices of a control group which is not using the system will be collected.

Detailed Description

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Inappropriate use of antimicrobials favours the spread and emergence of antimicrobial resistance and other adverse patient outcomes. Antimicrobial stewardship (AMS) programs aim to promote the appropriate use of antimicrobials. Most AMS interventions are based on manual, personalized peer review of antibiotic prescriptions by specialists and are therefore time and resource intensive. Informatics based, computerized approaches to AMS are a promising way to "automatize" AMS, but there have been only few randomized controlled trials analysing their effectiveness in the hospital setting.

The primary research question of this study is whether a multi-modal, computerized antibiotic stewardship intervention (I) reduces overall antibiotic exposure (O) in adult patients hospitalized in acute-care wards of secondary and tertiary care centers (P) compared to no such intervention ("standard-of- care") (C) over a one year time period (T) (the letters refer to the corresponding constituents of the PICOT framework).

The primary objective of the study is to use the methodological rigor of a parallel group, cluster-randomized, controlled superiority trial in three Swiss hospitals to answer the primary research question. Secondary objectives are to assess the impact of the intervention on quality of antibiotic use, patient, microbiologic and economic outcomes.

The primary outcome will be the difference in overall systemic antibiotic use measured in days of therapy (DOT) per admission based on administration data recorded in the electronic health record (EHR) over the whole intervention period. Secondary outcomes will include qualitative and quantitative antimicrobial use indicators (including non-HIV antivirals and antifungals), economic outcomes and key clinical and microbiologic indicators and patient safety indicators such as changes in readmission rates, need for intensive care and mortality.

The study hypothesis is that the multimodal intervention is superior to standard-of-care regarding the primary outcome, i.e. that the intervention leads to a statistically significant reduction in overall antibiotic use expressed as days of therapy per admission compared to no such intervention ("standard-of-care" antibiotic stewardship).

Conditions

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Communicable Diseases

Keywords

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Anti-Infective Agents Decision Support Systems, Clinical Quality Improvement

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Parallel group, cluster-randomized superiority trial
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Masking for care providers and investigators is unfortunately not feasible. Outcome assessors and data analysts will be blinded to the study arm allocation.

Study Groups

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Computerized decision support

Group Type EXPERIMENTAL

Computerized decision support and audit & feedback

Intervention Type OTHER

* suggestion of guideline concordant antimicrobial treatment based on indication entry in the computerized physician order entry system
* mandatory reevaluation of antimicrobial therapy therapy on calendar day 4 of treatment
* suggestion of standard antimicrobial treatment duration according to indication

Audit & Feedback

Intervention Type OTHER

\* regular (at least monthly) feedback of antibiotic use quality indicators (on the ward level)

Standard antibiotic stewardship

Intervention Type OTHER

* Infectious diseases consultation "on demand"
* Review of positive blood cultures
* Availability of a antibiotic use guidelines (on paper and as PDF)

Standard antibiotic stewardship

Group Type ACTIVE_COMPARATOR

Standard antibiotic stewardship

Intervention Type OTHER

* Infectious diseases consultation "on demand"
* Review of positive blood cultures
* Availability of a antibiotic use guidelines (on paper and as PDF)

Interventions

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Computerized decision support and audit & feedback

* suggestion of guideline concordant antimicrobial treatment based on indication entry in the computerized physician order entry system
* mandatory reevaluation of antimicrobial therapy therapy on calendar day 4 of treatment
* suggestion of standard antimicrobial treatment duration according to indication

Intervention Type OTHER

Audit & Feedback

\* regular (at least monthly) feedback of antibiotic use quality indicators (on the ward level)

Intervention Type OTHER

Standard antibiotic stewardship

* Infectious diseases consultation "on demand"
* Review of positive blood cultures
* Availability of a antibiotic use guidelines (on paper and as PDF)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

CLUSTER (WARD) LEVEL

* Acute-care wards with at least 150 admissions/year
* Use of a computerized physician order entry system (CPOE)

PHYSICIAN LEVEL \* All physicians involved in antibiotic prescribing decisions in the participating wards

PATIENT LEVEL

\* All patients hospitalized in the participating wards

Exclusion Criteria

CLUSTER (WARD) LEVEL

* Emergency room
* Outpatient clinics
* Overflow wards
* Absence of a matchable wards with regard to specialty and baseline antibiotic use
* Hematopoietic stem cell

PHYSICIAN LEVEL \* None

PATIENT LEVEL

\* None
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Swiss National Science Foundation

OTHER

Sponsor Role collaborator

University of Geneva, Switzerland

OTHER

Sponsor Role collaborator

Ente Ospedaliero Cantonale, Ticino, Switzerland

OTHER

Sponsor Role collaborator

Benedikt Huttner

OTHER

Sponsor Role lead

Responsible Party

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Benedikt Huttner

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Benedikt D Huttner, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Geneva University Hospitals and University of Geneva

Locations

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Geneva University Hospitals

Geneva, Canton of Geneva, Switzerland

Site Status

Ente Ospedaliera Cantonale - Ospedale San Giovanni

Bellinzona, Canton Ticino, Switzerland

Site Status

Ente Ospedaliera Cantonale - Ospedale Civico

Lugano, Canton Ticino, Switzerland

Site Status

Countries

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Switzerland

References

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Catho G, De Kraker M, Waldispuhl Suter B, Valotti R, Harbarth S, Kaiser L, Elzi L, Meyer R, Bernasconi E, Huttner BD. Study protocol for a multicentre, cluster randomised, superiority trial evaluating the impact of computerised decision support, audit and feedback on antibiotic use: the COMPuterized Antibiotic Stewardship Study (COMPASS). BMJ Open. 2018 Jun 27;8(6):e022666. doi: 10.1136/bmjopen-2018-022666.

Reference Type BACKGROUND
PMID: 29950480 (View on PubMed)

Catho G, Centemero NS, Catho H, Ranzani A, Balmelli C, Landelle C, Zanichelli V, Huttner BD; on the behalf of the Q-COMPASS study group. Factors determining the adherence to antimicrobial guidelines and the adoption of computerised decision support systems by physicians: A qualitative study in three European hospitals. Int J Med Inform. 2020 Sep;141:104233. doi: 10.1016/j.ijmedinf.2020.104233. Epub 2020 Jul 13.

Reference Type RESULT
PMID: 32736330 (View on PubMed)

Catho G, Sauser J, Coray V, Da Silva S, Elzi L, Harbarth S, Kaiser L, Marti C, Meyer R, Pagnamenta F, Portela J, Prendki V, Ranzani A, Centemero NS, Stirnemann J, Valotti R, Vernaz N, Suter BW, Bernasconi E, Huttner BD; COMPASS study group. Impact of interactive computerised decision support for hospital antibiotic use (COMPASS): an open-label, cluster-randomised trial in three Swiss hospitals. Lancet Infect Dis. 2022 Oct;22(10):1493-1502. doi: 10.1016/S1473-3099(22)00308-5. Epub 2022 Jul 20.

Reference Type DERIVED
PMID: 35870478 (View on PubMed)

Related Links

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Other Identifiers

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407240_167079

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2017-00454

Identifier Type: -

Identifier Source: org_study_id