982. A Cluster Randomized Trial of Two Strategies to Improve Antibiotic Use in Patients with Complicated Urinary Tract Infections
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • Poster_IDSA2013.pdf (110.6 kB)
  • Background: Up to 50% of hospital antibiotic use is inappropriate and therefore improvement strategies are urgently needed. We compared the effectiveness of two strategies to improve the quality of antibiotic use in patients with complicated urinary tract infections (UTIs).

    Methods: We conducted a multicentre, cluster-randomized trial among 19 university and non-university hospitals located throughout the Netherlands. In each hospital the departments Internal Medicine and Urology participated. Hospitals were randomized to either a multifaceted strategy (MFS) including education, feedback sessions, reminders and the initiation of local process analysis, or a ‘public reporting strategy (PRS)’, i.e. providing public comparative information on the hospital departments’ quality of antibiotic use for complicated UTIs. A baseline measurement in 2008 and a post-intervention measurement in 2011 was performed in 50 patients per department. Principal outcome measures were nine validated, previously developed, guideline-based quality indicators (QIs) to define appropriate antibiotic use in patients with complicated UTIs. Data were extracted from medical charts. Effects were quantified via a logistic regression model. Clustering at department and hospital level was taken into account through the inclusion of random effects. We controlled for gender, age and urological comorbidity.

    Results: For baseline and post-intervention measurements we included 1,964 and 2,027 patients respectively. For the entire sample, performance scores on the QIs showed an improving trend from baseline to post-intervention measurement. No significant differences were shown between both strategies in the improvement of each QI score. However, whereas performing a urine culture increased in both intervention groups (MFS: 73% to 80%, p=0.01 and PRS: 77% to 84%, p=0.005), the QIs ‘achieving pathogen-directed therapy’ (74% to 81%, p=0.03) and ‘treating UTI in men as complicated UTI’ (33% to 38%, p=0.05) improved significantly in the PRS group, but not in the MFS group.

    Conclusion: The effectiveness of both strategies seems equivalent, with a favourable trend for the public reporting strategy. Both evaluated strategies can help to improve antibiotic use, although the improvement may be limited.

    Veroniek Spoorenberg, Drs, MD1, Marlies E.J.L. Hulscher, Professor2, Ronald B. Geskus, PhD3, Theo M. De Reijke, MD, PhD4, Brent C. Opmeer, PhD5, Jan M. Prins, Professor, MD1 and Suzanne Geerlings, MD, PhD1, (1)Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, Netherlands, (2)Scientific Institute for Quality of Healthcare, Radboud Univ. Nijmegen Med. Ctr., Nijmegen, Netherlands, (3)Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands, (4)Department of Urology, Academic Medical Centre, Amsterdam, Amsterdam, Netherlands, (5)Clinical Research Unit, Academic Medical Centre of the University of Amsterdam, Amsterdam, Netherlands


    V. Spoorenberg, None

    M. E. J. L. Hulscher, None

    R. B. Geskus, None

    T. M. De Reijke, None

    B. C. Opmeer, None

    J. M. Prins, None

    S. Geerlings, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.