Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group

Schweitzer, Valentijn; Werkhoven, Cornelis H. van; Rodríguez-Baño, Jesús; Bielicki, Julia; Harbarth, Stéphan Juergen; Hulscher, Marlies; Huttner, Benedikt; Islam, Jasmin; Little, Paul; Pulcini, Céline; Savoldi, Alessia; Tacconelli, Evelina; Timsit, JF; Smeden, Maarten van; Wolkewitz, Martin; Bonten, Marc J. M.; Walker, A Sarah; Llewelyn, Martin J.

doi:10.1016/j.cmi.2019.08.017

Cited by 54 publications

(39 citation statements)

References 44 publications

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“…The strengths of our study are the ambidirectional design, allowing for a prospective evaluation of the antimicrobial stewardship intervention; the length of the study period to account for secular time trends [ 31 ]; and the availability of isolates for WGS analysis to prove genetic linkage.…”

Section: Discussionmentioning

confidence: 99%

Combined antibiotic stewardship and infection control measures to contain the spread of linezolid-resistant Staphylococcus epidermidis in an intensive care unit

Papan

Schröder

Hoffmann

et al. 2021

Antimicrob Resist Infect Control

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Background The unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). We report the effects of combined antibiotic stewardship and infection control measures on the spread of LRSE in an intensive care unit (ICU). Methods Microbiological data were reviewed to identify all LRSE detected in clinical samples at an ICU in southwest Germany. Quantitative data on the use of antibiotics with Gram-positive coverage were obtained in defined daily doses (DDD) per 100 patient-days (PD). In addition to infection control measures, an antibiotic stewardship intervention was started in May 2019, focusing on linezolid restriction and promoting vancomycin, wherever needed. We compared data from the pre-intervention period (May 2018–April 2019) to the post-intervention period (May 2019–April 2020). Whole-genome sequencing (WGS) was performed to determine the genetic relatedness of LRSE isolates. Results In the pre-intervention period, LRSE were isolated from 31 patients (17 in blood cultures). The average consumption of linezolid and daptomycin decreased from 7.5 DDD/100 PD and 12.3 DDD/100 PD per month in the pre-intervention period to 2.5 DDD/100 PD and 5.7 DDD/100 PD per month in the post-intervention period (p = 0.0022 and 0.0205), respectively. Conversely, vancomycin consumption increased from 0.2 DDD/100 PD per month to 4.7 DDD/100 PD per month (p < 0.0001). In the post-intervention period, LRSE were detected in 6 patients (4 in blood cultures) (p = 0.0065). WGS revealed the predominance of one single clone. Conclusions Complementing infection control measures by targeted antibiotic stewardship interventions was beneficial in containing the spread of LRSE in an ICU.

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Section: Discussionmentioning

confidence: 99%

Combined antibiotic stewardship and infection control measures to contain the spread of linezolid-resistant Staphylococcus epidermidis in an intensive care unit

Papan

Schröder

Hoffmann

et al. 2021

Antimicrob Resist Infect Control

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“… 25 Recommendations for designing studies to evaluate AMS interventions have recently been published. 26 A quasiexperimental design can provide an estimation of the impact of specific interventions and is used when randomisation is not feasible for ethical or logistical reasons. However, a quasiexperimental study has limitations.…”

Section: Discussionmentioning

confidence: 99%

Quasiexperimental intervention study protocol to optimise the use of new antibiotics in Spain: the NEW_SAFE project

et al. 2020

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IntroductionCeftaroline, tedizolid, dalbavancin, ceftazidime-avibactam and ceftolozane-tazobactam are novel antibiotics used to treat infections caused by multidrug-resistant pathogens (MDR). Their use should be supervised and monitored as part of an antimicrobial stewardship programme (ASP). Appropriate use of the new antibiotics will be improved by including consensual indications for their use in local antibiotic guidelines, together with educational interventions providing advice to prescribers to ensure that the recommendations are clearly understood.Methods and analysisThis study will be implemented in two phases. First, a preliminary historical cohort (2017–2019) of patients from 13 Andalusian hospitals treated with novel antibiotics will be analysed. Second, a quasiexperimental intervention study will be developed with an interrupted time-series analysis (2020–2021). The intervention will consist of an educational interview between prescribers and ASP leaders at each hospital to reinforce the proper use of novel antibiotics. The educational intervention will be based on a consensus guideline designed and disseminated by leaders after the retrospective cohort data have been analysed. The outcomes will be acceptance of the intervention and appropriateness of prescription. Incidence of infection and colonisation with MDR organisms as well as incidence ofClostridioides difficileinfection will also be analysed. Changes in prescription quality between periods and the safety profile of the antibiotics in terms of mortality rate and readmissions will also be measured.Ethics and disseminationEthical approval will be obtained from the Andalusian Coordinating Institutional Review Board. The study is being conducted in compliance with the protocol and regulatory requirements consistent with International Council of Harmonisation E6 Good Clinical Practice and the ethical principles of the latest version of the Declaration of Helsinki. The results will be published in peer-reviewed journals and disseminated at national and international conferences.Trial registration numberNCT03941951.

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“…All readers would bene t in knowing the context, the means, and other details of the intervention (31)(32)(33)(34)(35). Many studies developed frameworks for reporting and/or assessing interventions (36)(37)(38)(39)(40)(41), but few included parameters linked to the social-ecological context of interventions, speci cally in an AMR system. The scienti c literature is in need of a new de nition and understanding of AMR interventions, including a global contextualization of it as we de ned an intervention primarily in our study.…”

Section: Black Box Of Intervention Implementationmentioning

confidence: 99%

Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: Analysis of 42 interventions targeting E. coli

Léger¹,

Lambraki

Graells

et al. 2021

Preprint

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Background. Antimicrobial resistance (AMR) is among the most pressing One Health issues. While interventions and policies with various targets and goals have been implemented, evidence about factors underpinning success and failure of interventions in different sectors is lacking. The objective of this study is to identify characteristics of AMR interventions that increase their capacity to impact AMR. This study focuses on AMR interventions targeting E. coli.Methods. We used the AMR-Intervene framework to extract descriptions of the social and ecological systems of interventions to determine factors contributing to their success. Results. We identified 52 scientific publications referring to 42 unique E. coli AMR interventions. We mainly identified interventions implemented in high-income countries (36/42), at the national level (16/42), targeting primarily one sector of society (37/42) that was mainly the human sector (25/42). Interventions were primarily funded by governments (38/42). Most intervention targeted a low leverage point in the AMR system, (36/42), and aimed to change the epidemiology of AMR (14/42). Among all included publications, 55% (29/52) described at least one success factor or obstacle (29/52) and 19% (10/52) identified at least one success factor and one obstacle. Most reported success factors related to communication between the actors and stakeholders and the role of media, and stressed the importance of collaboration between disciplines and external partners. Described obstacles covered data quality, access to data and statistical analyses, and the validity of the results. Conclusions. Overall, we identified a lack of diversity regarding interventions. In addition, most published E. coli interventions were poorly described with limited evidence of the factors that contributed to the intervention success or failure. Design and reporting guidelines would help to improve reporting quality and provide a valuable tool for improving the science of AMR interventions.

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Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group

Cited by 54 publications

References 44 publications

Combined antibiotic stewardship and infection control measures to contain the spread of linezolid-resistant Staphylococcus epidermidis in an intensive care unit

Combined antibiotic stewardship and infection control measures to contain the spread of linezolid-resistant Staphylococcus epidermidis in an intensive care unit

Quasiexperimental intervention study protocol to optimise the use of new antibiotics in Spain: the NEW_SAFE project

Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: Analysis of 42 interventions targeting E. coli

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