title: A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist.
abstract: BACKGROUND
  Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can be achieved. Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of (cost-) effectiveness.
  
  
  METHODS
  The checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route. A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least 810 patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Secondary endpoints are appropriate antibiotic use measured by the quality indicators, admission to and duration of intensive care unit stay, readmission within 30 days, mortality, total antibiotic use, and costs associated with implementation and hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used. A process evaluation will be performed to evaluate the professionals' compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist.
  
  
  CONCLUSIONS
  If (cost-) effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics.
  
  
  BACKGROUND
  Dutch trial registry: NTR4872.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. f.v.vandaalen@amc.uva.nl.
authors.forename: Frederike V
authors.initials: FV
authors.lastname: van Daalen
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.m.prins@amc.uva.nl.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Clinical Research Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. b.c.opmeer@amc.uva.nl.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Opmeer
authors.affiliation: Department of General Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. m.a.boermeester@amc.uva.nl.
authors.forename: Marja A
authors.initials: MA
authors.lastname: Boermeester
authors.affiliation: Department of Medical Microbiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. c.e.visser@amc.uva.nl.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Visser
authors.affiliation: Department of Hospital Pharmacy, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. r.m.vanhest@amc.uva.nl.
authors.forename: Reinier M
authors.initials: RM
authors.lastname: van Hest
authors.affiliation: Department of IQ healthcare, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, Netherlands. Marlies.hulscher@radboudumc.nl.
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.e.geerlings@amc.uva.nl.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D057189:Checklist / Q000191:economics / Q000379:methods / Q000592:standards; D003362:Cost-Benefit Analysis; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D010347:Patient Care Planning / Q000191:economics / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D012042:Registries / Q000706:statistics & numerical data; D012107:Research Design
chemical_list: D000900:Anti-Bacterial Agents