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J Antimicrob Chemother. 2014 Aug;69(8):2265-73. doi: 10.1093/jac/dku115. Epub 2014 Apr 28.

Impact of implementation of a novel antimicrobial stewardship tool on antibiotic use in nursing homes: a prospective cluster randomized control pilot study.

Author information

1
Centre for Ethnicity and Infection and Microbiology Department, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK.
2
Centre for Ethnicity and Infection and Microbiology Department, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK ggopalrao@nhs.net.
3
Public Health England, Public Health Laboratory London, Division of Infection, Barts Health NHS Trust, Whitechapel, London E1 2ES, UK.
4
Division of Infection and Immunity, University College London, Gower Street, London WC1E 6BT, UK.
5
Public Health England Colindale, 61 Colindale Avenue, London NW9 5HT, UK.
6
School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK.
7
Population Health Sciences Division, Medical Research Institute, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.

Abstract

OBJECTIVES:

To evaluate the impact of 'Resident Antimicrobial Management Plan' (RAMP), a novel antimicrobial stewardship tool on systemic antibiotic use for treatment of infection in nursing homes (NHs).

METHODS:

A pilot cluster randomized control study was conducted in 30 NHs in London. Pre-intervention, we collected point prevalence data on antimicrobial use on three occasions and total antimicrobial consumption for a 12 week period. Post-intervention data were collected in the same manner and included assessment of compliance with RAMP in the intervention group (IG).

RESULTS:

The number of residents included was 1628 pre-intervention [825 IG/803 control group (CG)] and 1610 post-intervention (838 IG/772 CG). The corresponding pre- and post-intervention point prevalence of systemic antibiotic prescribing for treatment of infection was 6.46% and 6.52% in the IG [estimated prevalence ratio: 1.01 (95% CI: 0.81-1.25), P = 0.94] compared with 5.27% and 5.83%, respectively, in the CG [estimated prevalence ratio: 1.11 (95% CI: 0.87-1.41), P = 0.4]. Total antibiotic consumption was 69.78 defined daily doses/1000 residents/day (DRD) pre-intervention and 66.53 DRD post-intervention in the IG compared with 49.68 and 51.92 DRD, respectively, in the CG. There was a significant decrease of 4.9% (3.25 DRD) in the IG (95% CI: 1.0%-8.6%) (P = 0.02) compared with a significant increase of 5.1% (2.24 DRD) in the CG (95% CI: 0.2%-10.2%) (P = 0.04). Main indications for antibiotics were lower respiratory tract infections (34.1%), urinary tract infections (28.5%) and skin/soft tissue infections (25.1%).

CONCLUSIONS:

This pilot study demonstrated that use of RAMP was associated with a statistically significant decrease in total antibiotic consumption and has the potential to be an important antimicrobial stewardship tool for NHs.

KEYWORDS:

general practice; healthcare-associated infections; long-term care; prescribing; quality improvement

PMID:
24777901
DOI:
10.1093/jac/dku115
[Indexed for MEDLINE]

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