The impact of a weekly antimicrobial stewardship team intervention on antibiotic prescriptions in Dutch nursing...

Inappropriate prescribing of antibiotics for suspected urinary tract infections (UTI), respiratory tract infections (RTI) and skin and soft tissue infections (SSTI) in nursing homes (NHs) is common. Antimicrobial stewardship (AMS) has proven effectiveness in reducing inappropriate antibiotic prescriptions in hospitals. AMS has not been widely adopted in NHs due to limited evidence of its effectiveness in that setting. Therefore, the aim of this study is to evaluate the effect of a weekly AMS team on appropriate antibiotic prescribing in NHs. An additional aim is to determine internal and external validity and identify barriers and facilitators of implementing the intervention.

In this multicentre, two-arm, randomised, controlled, non-blinded trial in Dutch NHs, four medical microbiology laboratories with their clinical microbiologists and eight NH organisations participate. NH clinicians will be randomised to the intervention or control arm (usual care) in a 1:1 ratio. The intervention consists of a weekly AMS intervention per NH organisation where audit and feedback is provided by a clinical microbiologist during 36 weeks. The primary outcome is the incidence rate (IR) of inappropriate antibiotic prescriptions per clinician per week. A sample size of 54 clinicians will be sufficient to demonstrate a reduction of 35% in the IR of inappropriate prescriptions, with a power of 90% at alpha = 0.05. Secondary outcomes are the IR of total antibiotic prescriptions, and the IR of inappropriate prescriptions with 95%CI will be estimated per arm and compared using univariable Poisson regression.

This RCT will evaluate whether an AMS intervention in Dutch NHs results in a reduction in the incidence rate of inappropriate antibiotic prescriptions for the most common infections in NHs; a parallel process evaluation will inform possible future implementation. If proven effective, AMS should be considered for NHs.

The Medical Ethics Committee of the Amsterdam University Medical Center waived ethical approval for this study. Written informed consent is obtained from all participants. Outcomes will be published in a peer-reviewed journal.

ClinicalTrials.gov NCT05998226. Registered on August 18, 2023.