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BMC Infect Dis. 2015 Mar 19;15:134. doi: 10.1186/s12879-015-0867-2.

A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist.

Author information

1
Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. f.v.vandaalen@amc.uva.nl.
2
Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.m.prins@amc.uva.nl.
3
Clinical Research Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. b.c.opmeer@amc.uva.nl.
4
Department of General Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. m.a.boermeester@amc.uva.nl.
5
Department of Medical Microbiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. c.e.visser@amc.uva.nl.
6
Department of Hospital Pharmacy, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. r.m.vanhest@amc.uva.nl.
7
Department of IQ healthcare, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, Netherlands. Marlies.hulscher@radboudumc.nl.
8
Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.e.geerlings@amc.uva.nl.

Abstract

BACKGROUND:

Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can be achieved. Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of (cost-) effectiveness.

METHODS/DESIGN:

The checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route. A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least 810 patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Secondary endpoints are appropriate antibiotic use measured by the quality indicators, admission to and duration of intensive care unit stay, readmission within 30 days, mortality, total antibiotic use, and costs associated with implementation and hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used. A process evaluation will be performed to evaluate the professionals' compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist.

DISCUSSION:

If (cost-) effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics.

TRIAL REGISTRATION:

Dutch trial registry: NTR4872.

PMID:
25888180
PMCID:
PMC4369057
DOI:
10.1186/s12879-015-0867-2
[Indexed for MEDLINE]
Free PMC Article

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