An audit and feedback intervention study increased adherence to antibiotic prescribing guidelines at a Norwegian hospital

Abstract

BackgroundAppropriate antibiotic prescribing is associated with favourable levels of antimicrobial resistance (AMR) and clinical outcomes. Most intervention studies on antibiotic prescribing originate from settings with high level of AMR. In a Norwegian hospital setting with low level of AMR, the literature on interventions for promoting guideline-recommended antibiotic prescribing in hospital is scarce and requested. Preliminary studies have shown improvement potentials regarding antibiotic prescribing according to guidelines. We aimed to promote appropriate antibiotic prescribing in patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at a respiratory medicine department in a Norwegian University hospital. Our specific objectives were to increase prescribing of appropriate empirical antibiotics, reduce high-dose benzylpenicillin and reduce total treatment duration.MethodsWe performed an audit and feedback intervention study, combined with distribution of a recently published pocket version of the national clinical practice guideline. We included patients discharged with CAP or AECOPD and prescribed antibiotics during hospital stay, and excluded those presenting with aspiration, nosocomial infection and co-infections. The pre- and post-intervention period was 9 and 6 months, respectively. Feedback was provided orally to the department physicians at an internal-educational meeting. To explore the effect of the intervention on appropriate empirical antibiotics and mean total treatment duration we applied before-after analysis (Student’s t-test) and interrupted time series (ITS). We used Pearson’s χ2 to compare dose changes.ResultsIn the pre-and post-intervention period we included 253 and 155 patients, respectively. Following the intervention, overall mean prescribing of appropriate empirical antibiotics increased from 61.7 to 83.8 % (P < 0.001), overall mean total treatment duration decreased from 11.2 to 10.4 days (P = 0.015), and prescribing of high-dose benzylpenicillin decreased from 48.8 to 38.6 % (P = 0.125). With ITS we found that six months post-intervention, the effect on appropriate empirical antibiotic prescribing had increased and sustained, while the effect on treatment duration was at pre-intervention level.ConclusionThe combination of audit and feedback plus distribution of a pocket version of guideline recommendations led to a substantial increase in prescribing of appropriate empirical antibiotics, which is important due to favourable effect on AMR and clinical outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1426-1) contains supplementary material, which is available to authorized users.

Behandling av pneumoni oppstått utenfor sykehus

“…Mange av disse fikk ikke nedjustert dosen, men hvis dette ble gjort, var det stort sett først ved utskrivelse. Dette samsvarer med funn i en studie av Høgli et al (19), hvor man etter intervensjon reduserte dosene av penicillin med 10 % uten at det gikk ut over behandlingsresultatet. Betalaktamantibiotikaenes bakteriedrepende evne avhenger av hvor lenge konsentrasjonen er over minste hemmende konsentrasjon (minimal inhibitory concentration, MIC) og ikke av toppkonsentrasjonen (20).…”

“…Åtte (11 %) av pasientene anga penicillinallergi. Dette er i samsvar med flere studier (19,21). Man antar imidlertid at den reelle andelen av alvorlig penicillinallergi (type 1) er under 0,05 % (22).…”

“…Behandlingsvarigheten fulgte ikke anbefalingene i retningslinjene. Det samsvarer med funnene i studien til Høgli et al, der man reduserte behandlingslengden med ett døgn etter intervensjon (19). Denne reduksjonen var imidlertid forbigående.…”

The methodological quality of guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia: A systematic review

“…-The newer version of the guideline was included in this review: n = 1 [32] -Guideline adherence : n = 5 [5,7,[33][34][35] -Guideline on prevention: n = 2 [36][37] -Non specific HAP/VAP guideline: n = 5 [38][39][40][41][42] 3 [13,[43][44] -Not a guideline (before and after study/protocol/algorithm) : n = -Guideline on specific population: n = 1 [45] -Summary of the included guidelines: n = 2 [46][47] Full-text guidelines assessed for eligibility (n = 25) (Table 1).…”

The effect of the implementation of evidence-based drug formulary on antibacterial use in a private hospital at Tanjung Enim, Sumatera Selatan, Indonesia

“…The habit of prescribing antibacterial in inappropriate dose (usually under-dose), incorrect frequency, or for a too short or too long duration will reduce their efficacy and create serious resistance problem. 6 In order to ensure appropriate and rational use of antibacterial, particularly in the healthcare institution/hospital environment, the principles of antibacterial stewardship should be applied consistently. One of the principles is the development of evidencebased formulary.…”