1676. The Effect of an Antibiotic Checklist Based on Validated Quality Indicators on Length of Hospital Stay in Hospitalized Patients: a Cluster Randomized Trial 
Session: Oral Abstract Session: MultiCenter Stewardship Interventions
Friday, October 28, 2016: 2:45 PM
Room: 288-290
Background: Quality indicators (QI) have been developed to define appropriate antibiotic use in hospitalized patients. A checklist based on these QIs could be a useful tool to promote appropriate antibiotic use in daily practice.

Methods: We developed an antibiotic checklist, which applied to hospitalized adult non-ICU patients with a bacterial infection in whom intravenous (IV) antibiotic therapy was initiated. It was divided into two bundles; the first should be completed at start of treatment, and the second during the first 72 hours of treatment.

The checklist was implemented in nine Dutch hospitals using a stepped wedge study design (SWD) (figure 1). Outcomes before (baseline) and after introduction of the checklist (intervention) were compared with mixed effect models. The number of patients included in the baseline period was determined by a power analysis; in the intervention period all eligible patients were included. The primary endpoint was length of stay (LOS); secondary endpoint was appropriate antibiotic use measured by the QIs.

 

Results: For 1207 (23.2%) of all eligible patients (n=5352) a checklist was completed. In an intention-to-treat analysis 853 baseline patients were compared with 5352 intervention patients. The geometric mean of LOS did not change [7.6 vs 7.8 days, P = 0.46]. However, the score per QI, and the total sum score of QIs (table 1) increased significantly for patients with a completed checklist as compared to patients in the baseline group.

Conclusion: Use of an antibiotic checklist resulted in a significant increase in appropriate antibiotic use, but this did not translate in a reduction in LOS, wherefore patient selection is the most likely explanation.

Figure 1: SWD

Table 1: QIs score

Bundle

QI

Baseline (n = 853)

Checklist (n = 1207)

 

 

Score %

Score %

OR*

CI (95%)

P

1

Blood cultures

46.5

70.4

3.22

2.59-4.00

<0.001

Cultures of suspected site of infection

46.6

50.5

1.18

0.90-1.53

0.27

Guideline adherence

45.6

55.8

1.47

1.21-1.79

<0.001

Adjustment to renal function

34.0

44.6

1.40

0.84-2.34

0.20

Documented antibiotic plan

87.0

90.0

1.55

1.13-2.12

0.006

2

De-escalation

33.7

41.8

1.47

1.04-2.09

0.03

IV-oral switch

56.2

66.8

1.52

1.15-2.02

0.003

 

SUMSCORE ≥ 50%

67.5

83.4

2.54

2.01-3.21

<0.001

* based on generalised linear mixed models

 

Frederike V. Van Daalen, MD1, Jan M. Prins, Professor, MD1, Brent C. Opmeer, PhD1, Marja Boermeester, Professor, MD1, Caroline E. Visser, MD, PhD1, Reinier M. Van Hest, PharmD, PhD1, Marlies E.J.L. Hulscher, Professor2 and Suzanne E. Geerlings, Professor, MD1, (1)Academic Medical Center, Amsterdam, Netherlands, (2)Radboud University Medical Center, Nijmegen, Netherlands

Disclosures:

F. V. Van Daalen, None

J. M. Prins, None

B. C. Opmeer, None

M. Boermeester, None

C. E. Visser, None

R. M. Van Hest, None

M. E. J. L. Hulscher, None

S. E. Geerlings, None

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