Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial - PubMed (original) (raw)

Randomized Controlled Trial

Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial

Bernard C Camins et al. Infect Control Hosp Epidemiol. 2009 Oct.

Abstract

Background: Multidisciplinary antimicrobial utilization teams (AUTs) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited.

Objective: To determine the impact of an AUT on antimicrobial use at a teaching hospital.

Design: Randomized controlled intervention trial.

Setting: A 953-bed, public, university-affiliated, urban teaching hospital.

Patients: Patients who were given selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams.

Intervention: Twelve internal medicine teams were randomly assigned monthly: 6 teams to an intervention group (academic detailing by the AUT) and 6 teams to a control group that was given indication-based guidelines for prescription of broad-spectrum antimicrobials (standard of care), during a 10-month study period.

Measurements: Proportion of appropriate empirical, definitive (therapeutic), and end (overall) antimicrobial usage.

Results: A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of antimicrobial prescriptions written by the intervention teams that was considered to be appropriate was significantly higher than the proportion of antimicrobial prescriptions written by the control teams that was considered to be appropriate: 82% versus 73% for empirical (risk ratio [RR], 1.14; 95% confidence interval [CI], 1.04-1.24), 82% versus 43% for definitive (RR, 1.89; 95% CI, 1.53-2.33), and 94% versus 70% for end antimicrobial usage (RR, 1.34; 95% CI, 1.25-1.43). In multivariate analysis, teams that received feedback from the AUT alone (adjusted RR, 1.37; 95% CI, 1.27-1.48) or from both the AUT and the infectious diseases consultation service (adjusted RR, 2.28; 95% CI, 1.64-3.19) were significantly more likely to prescribe end antimicrobial usage appropriately, compared with control teams.

Conclusions: A multidisciplinary AUT that provides feedback to prescribing physicians was an effective method in improving antimicrobial use. Trial registration. ClinicalTrials.gov identifier: NCT00552838.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

Disclosures: Bernard C. Camins, M.D. is on the Speaker’s Bureau for Wyeth Pharmaceuticals. The other authors have no potential conflicts of interest to disclose.

Comment in

Similar articles

Cited by

References

    1. US Congress, Office of Technology Assessment. Impact of Antibiotic-Resistant Bacteria (OTA-H-629) Washington, D.C: U.S. Government Printing Office; 1995. Ref Type: Report.
    1. Whitney CG, Farley MM, Hadler J, et al. Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med. 2000;343:1917–1924. - PubMed
    1. Fridkin SK, Edwards JR, Tenover FC, Gaynes RP, McGowan JE., Jr Antimicrobial resistance prevalence rates in hospital antibiograms reflect prevalence rates among pathogens associated with hospital-acquired infections. Clin Infect Dis. 2001;33:324–330. - PubMed
    1. Fridkin SK, Hill HA, Volkova NV, et al. Temporal changes in prevalence of antimicrobial resistance in 23 US hospitals. Emerg Infect Dis. 2002;8:697–701. - PMC - PubMed
    1. Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA. 2003;289:885–888. - PubMed

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources