Educational intervention to reduce treatment of asymptomatic bacteriuria in long-term care

Lee, Christine; Phillips, Casey; Vanstone, Jason

doi:10.1136/bmjoq-2018-000483

Cited by 23 publications

(12 citation statements)

References 16 publications

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“…One study evaluated the impact of an educational intervention to improve antibiotic use for UTIs in 10 Canadian LTCFs and reported a 26% decrease (adjusted incidence rate ratio=0.74, 95% CI: 0.47 to 0.74) in the overall number of antibiotic prescriptions per 1000 resident days 10. The second study, in seven Canadian LTCFs, reported a decrease in the use of antibiotics for asymptomatic bacteriuria from 90% pre-intervention to 62.9% post-intervention (p=0.003), following an educational intervention 73. The third study reported that the implementation of new guidelines and physician-pharmacy-nurse quality circles resulted in a 22% reduction in overall antibiotic use over a 6-year period 74.…”

Section: Discussionmentioning

confidence: 98%

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Raban

Gasparini

et al. 2020

BMJ Open

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ObjectivesThere are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and CINAHL from 1997 until November 2018.Eligibility criteriaControlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations.Data extraction and synthesisTwo reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results.ResultsOf include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers.ConclusionsThere is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.

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Section: Discussionmentioning

confidence: 98%

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Raban

Gasparini

et al. 2020

BMJ Open

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“…Lee and colleagues undertook an evaluation of an educational intervention related to ASB in patients at 7 LTC facilities in Regina, Saskatchewan, Canada, with the primary outcome of percentage of residents who received inappropriate antibiotic treatment for ASB [23]. There was a pre-assessment period and a postassessment period of 5 weeks each, and the intervention took place during the 2 weeks in between.…”

Section: Resultsmentioning

confidence: 99%

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2018

Chahine

Durham

Mediwala

et al. 2019

Open Forum Infectious Diseases

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With an increasing number of antimicrobial stewardship–related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2018. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training as well as to identify potential intervention opportunities within one’s institution.

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“…Around the world, it has become evident that there is a need to strengthen medical education by avoiding the prescription of antimicrobials in cases that do not warrant it. In this study, we identified cases without indication for antimicrobial use, including asymptomatic bacteriuria (ASB) and colonization ( n = 17, 12.0%) [ 25 ]. Another issue to highlight is that no dosing adjustments were seen in eight hemodialyzed patients, bearing in mind that up to 50% of meropenem is removed during this process, and so a dose is required after each session [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Real-World Use of Generic Meropenem: Results of an Observational Study

S¹,

Aristizábal-Ruiz²,

Álvarez-Moreno

2021

Antibiotics

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Background: To determine the therapeutic effect and tolerability of meropenem in routine clinical practice, in terms of clinical and microbiological response. Methods: A real-world, observational, descriptive, longitudinal study with daily monitoring of clinical history records was conducted on all patients who were medically prescribed meropenem during a period between October 2015 and March 2016 at a university hospital in Bucaramanga (Colombia). Results: The study evaluated 84 patients with an average age of 63.2 years, mostly older adults with multiple comorbidities, of whom 54.8% were men. A positive clinical or microbiological response was obtained in 98.8% of the patients. At the end of the treatments, significant improvements in dysthermia (0% vs. 29% at the beginning, p = 0.000), tachycardia (13% vs. 47%, p = 0.049), and leukocytosis (39% vs. 15% at the beginning, p = 0.008) were evidenced. The improvement in the indicator that combines all the Systemic Inflammatory Response Syndrome (SIRS) criteria was also significant (p = 0.000). The treatment was well tolerated, although we identified some non-serious and expected adverse reactions. Conclusions: Generic meropenem proved to be effective and well tolerated for different types of infection in routine clinical practice. The results are consistent with the findings of the clinical studies with the innovator drug.

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Educational intervention to reduce treatment of asymptomatic bacteriuria in long-term care

Cited by 23 publications

References 16 publications

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2018

Real-World Use of Generic Meropenem: Results of an Observational Study

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