Impact of implementation of a novel antimicrobial stewardship tool on antibiotic use in nursing homes: a prospective cluster randomized control pilot study.
OBJECTIVE
To evaluate the impact of 'Resident Antimicrobial Management Plan' (RAMP), a novel antimicrobial stewardship tool on systemic antibiotic use for treatment of infection in nursing homes (NHs).


METHODS
A pilot cluster randomized control study was conducted in 30 NHs in London. Pre-intervention, we collected point prevalence data on antimicrobial use on three occasions and total antimicrobial consumption for a 12 week period. Post-intervention data were collected in the same manner and included assessment of compliance with RAMP in the intervention group (IG).


RESULTS
The number of residents included was 1628 pre-intervention [825 IG/803 control group (CG)] and 1610 post-intervention (838 IG/772 CG). The corresponding pre- and post-intervention point prevalence of systemic antibiotic prescribing for treatment of infection was 6.46% and 6.52% in the IG [estimated prevalence ratio: 1.01 (95% CI: 0.81-1.25), P = 0.94] compared with 5.27% and 5.83%, respectively, in the CG [estimated prevalence ratio: 1.11 (95% CI: 0.87-1.41), P = 0.4]. Total antibiotic consumption was 69.78 defined daily doses/1000 residents/day (DRD) pre-intervention and 66.53 DRD post-intervention in the IG compared with 49.68 and 51.92 DRD, respectively, in the CG. There was a significant decrease of 4.9% (3.25 DRD) in the IG (95% CI: 1.0%-8.6%) (P = 0.02) compared with a significant increase of 5.1% (2.24 DRD) in the CG (95% CI: 0.2%-10.2%) (P = 0.04). Main indications for antibiotics were lower respiratory tract infections (34.1%), urinary tract infections (28.5%) and skin/soft tissue infections (25.1%).


CONCLUSIONS
This pilot study demonstrated that use of RAMP was associated with a statistically significant decrease in total antibiotic consumption and has the potential to be an important antimicrobial stewardship tool for NHs.
Centre for Ethnicity and Infection and Microbiology Department, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK.
Elizabeth
E
Fleet
Centre for Ethnicity and Infection and Microbiology Department, North West London Hospitals NHS Trust, Watford Road, Harrow HA1 3UJ, UK ggopalrao@nhs.net.
G
G
Gopal Rao
Public Health England, Public Health Laboratory London, Division of Infection, Barts Health NHS Trust, Whitechapel, London E1 2ES, UK.
Bharat
B
Patel
Division of Infection and Immunity, University College London, Gower Street, London WC1E 6BT, UK.
Barry
B
Cookson
Public Health England Colindale, 61 Colindale Avenue, London NW9 5HT, UK.
Andre
A
Charlett
School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK.
Clive
C
Bowman
Population Health Sciences Division, Medical Research Institute, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.
Peter
P
Davey
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012874:Skin Diseases, Infectious / Q000188:drug therapy; D018461:Soft Tissue Infections / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy; D047090:beta-Lactams / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D047090:beta-Lactams
general practice; healthcare-associated infections; long-term care; prescribing; quality improvement