Tags

Type your tag names separated by a space and hit enter

Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial.
BMJ Open. 2021 Mar 02; 11(3):e046142.BO

Abstract

INTRODUCTION

Antimicrobial resistance is a growing global health threat, driven by increasing inappropriate use of antimicrobials. High prevalence of unnecessary use of antimicrobials in residential aged care facilities (RACFs) has driven demand for the development and implementation of antimicrobial stewardship (AMS) programmes. The Stepped-wedge Trial to increase antibiotic Appropriateness in Residential aged care facilities and model Transmission of antimicrobial resistance (START) will implement and evaluate the impact of a nurse-led AMS programme on antimicrobial use in 12 RACFs.

METHODS AND ANALYSIS

The START trial will implement and evaluate a nurse-led AMS programme via a stepped-wedge cluster randomised controlled trial design in 12 RACFs over 16 months. The AMS programme will incorporate education, aged care-specific treatment guidelines, documentation forms, and audit and feedback strategies that will target aged care staff, general practitioners, pharmacists, and residents and their families. The intervention will primarily focus on urinary tract infections, lower respiratory tract infections, and skin and soft tissue infections. RACFs will transition from control to intervention phases in random order, two at a time, every 2 months, with a 2-month transition, wash-in period. The primary outcome is the cumulative proportion of residents within each facility prescribed an antibiotic during each month and total days of antibiotic use per 1000 occupied bed days. Secondary outcomes include the number of courses of systemic antimicrobial therapy, antimicrobial appropriateness, antimicrobial resistant organisms, Clostridioides difficile infection, change in antimicrobial susceptibility profiles, hospitalisations and all-cause mortality. Analyses will be conducted according to the intention-to-treat principle.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/591). Research findings will be disseminated through peer-reviewed publications, conferences and summarised reports provided to participating RACFs.

TRIAL REGISTRATION NUMBER

NCT03941509.

Authors+Show Affiliations

Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.Monash Infectious Diseases, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia.Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia.Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia anton.peleg@monash.edu. Monash Biomedicine Discovery Institute, Infection and Immunity Theme, Department of Microbiology, Monash University, Clayton, Victoria, Australia.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33653766

Citation

Jokanovic, Natali, et al. "Multicentre Stepped-wedge Cluster Randomised Controlled Trial of an Antimicrobial Stewardship Programme in Residential Aged Care: Protocol for the START Trial." BMJ Open, vol. 11, no. 3, 2021, pp. e046142.
Jokanovic N, Haines T, Cheng AC, et al. Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial. BMJ Open. 2021;11(3):e046142.
Jokanovic, N., Haines, T., Cheng, A. C., Holt, K. E., Hilmer, S. N., Jeon, Y. H., Stewardson, A. J., Stuart, R. L., Spelman, T., Peel, T. N., & Peleg, A. Y. (2021). Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial. BMJ Open, 11(3), e046142. https://doi.org/10.1136/bmjopen-2020-046142
Jokanovic N, et al. Multicentre Stepped-wedge Cluster Randomised Controlled Trial of an Antimicrobial Stewardship Programme in Residential Aged Care: Protocol for the START Trial. BMJ Open. 2021 Mar 2;11(3):e046142. PubMed PMID: 33653766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial. AU - Jokanovic,Natali, AU - Haines,Terry, AU - Cheng,Allen C, AU - Holt,Kathryn E, AU - Hilmer,Sarah N, AU - Jeon,Yun-Hee, AU - Stewardson,Andrew J, AU - Stuart,Rhonda L, AU - Spelman,Tim, AU - Peel,Trisha N, AU - Peleg,Anton Y, AU - ,, Y1 - 2021/03/02/ PY - 2021/3/3/entrez PY - 2021/3/4/pubmed PY - 2021/3/4/medline KW - geriatric medicine KW - infectious diseases KW - public health SP - e046142 EP - e046142 JF - BMJ open JO - BMJ Open VL - 11 IS - 3 N2 - INTRODUCTION: Antimicrobial resistance is a growing global health threat, driven by increasing inappropriate use of antimicrobials. High prevalence of unnecessary use of antimicrobials in residential aged care facilities (RACFs) has driven demand for the development and implementation of antimicrobial stewardship (AMS) programmes. The Stepped-wedge Trial to increase antibiotic Appropriateness in Residential aged care facilities and model Transmission of antimicrobial resistance (START) will implement and evaluate the impact of a nurse-led AMS programme on antimicrobial use in 12 RACFs. METHODS AND ANALYSIS: The START trial will implement and evaluate a nurse-led AMS programme via a stepped-wedge cluster randomised controlled trial design in 12 RACFs over 16 months. The AMS programme will incorporate education, aged care-specific treatment guidelines, documentation forms, and audit and feedback strategies that will target aged care staff, general practitioners, pharmacists, and residents and their families. The intervention will primarily focus on urinary tract infections, lower respiratory tract infections, and skin and soft tissue infections. RACFs will transition from control to intervention phases in random order, two at a time, every 2 months, with a 2-month transition, wash-in period. The primary outcome is the cumulative proportion of residents within each facility prescribed an antibiotic during each month and total days of antibiotic use per 1000 occupied bed days. Secondary outcomes include the number of courses of systemic antimicrobial therapy, antimicrobial appropriateness, antimicrobial resistant organisms, Clostridioides difficile infection, change in antimicrobial susceptibility profiles, hospitalisations and all-cause mortality. Analyses will be conducted according to the intention-to-treat principle. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/591). Research findings will be disseminated through peer-reviewed publications, conferences and summarised reports provided to participating RACFs. TRIAL REGISTRATION NUMBER: NCT03941509. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/33653766/Multicentre_stepped-wedge_cluster_randomised_controlled_trial_of_an_antimicrobial_stewardship_programme_in_residential_aged_care:_protocol_for_the_START_trial. L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=33653766 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.