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This study evaluates the effectiveness of an antimicrobial stewardship program to reduce the length of stay of patients admitted to hospital with a diagnosis of pneumonia. The antimicrobial stewardship program will be implemented in several hospitals in Ontario, Canada. The program will identify patients with pneumonia, review their charts and make recommendations to their attending physicians about antibiotic management.
Antimicrobial stewardship is defined as any activity that promotes the appropriate selection, dosing, route and duration of antibiotic therapy. Antimicrobial stewardship programs usually include pharmacists and/or doctors with expertise in infection diseases management. Prospective chart review and physician feedback is a common intervention used by antimicrobial stewardship programs to improve antibiotic utilization and patient outcomes.
Pneumonia is the most common reason for antibiotic utilization in hospitals. Significant variation in antibiotic utilization for patients with pneumonia has been repeatedly demonstrated in published studies despite the existence of best-practice treatment guidelines. Treatment variation from these guidelines has been demonstrated to result in worse outcomes such as increased mortality. Antimicrobial stewardship programs can help reduce the treatment variation from guidelines.
Despite improvements in certain outcomes, antimicrobial stewardship programs have not demonstrated any impact on the length of stay of patients admitted to hospital with pneumonia. Part of this absence of evidence may be due to poor study design and failure to recruit sufficient patients. This study will include the implementation of an antimicrobial stewardship program across many hospitals and the study design and analysis will account for the design problems of the previous studies.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| intervention | exposure to antimicrobial stewardship intervention |
| |
| control | usual care with no exposure to antimicrobial stewardship |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| antimicrobial stewardship | Other | A member of the antimicrobial stewardship program will prospectively review the patient's medical record and make recommendations to the most responsible physician in the care of that patient |
| Measure | Description | Time Frame |
|---|---|---|
| Length of hospital stay | Time (measured in days) from date of admission to one of the following potential outcomes, discharge alive, censoring at 14 days post admission, death, admission to an intensive care unit, or transfer to another hospital | Days from time of admission to time of discharge from hospital to a maximum of 14 days from the date of admission (or time to censoring at 14 days from the date of admissionor competing event depending on which comes first) |
| Measure | Description | Time Frame |
|---|---|---|
| Days of antibiotic therapy | Total days of antibiotics administered for the treatment of community-acquired pneumonia | Days of antibiotic therapy for the treatment of pneumonia measured from the first day of antibiotic administered to the final day of antibiotic administered upto a maximum of 80 days |
| Mortality rate |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients over the age of 18 years admitted to a hospital ward with a diagnosis of community-acquired pneumonia as determined by the most responsible physician
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| Name | Affiliation | Role |
|---|---|---|
| Giulio DiDiodato, MD | Physician | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Royal Victoria Regional Health Centre | Barrie | Ontario | L4M6M2 | Canada |
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| ID | Term |
|---|---|
| D011014 | Pneumonia |
| D000098968 | Community-Acquired Pneumonia |
| ID | Term |
|---|---|
| D012141 | Respiratory Tract Infections |
| D007239 | Infections |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
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| ID | Term |
|---|---|
| D000073602 | Antimicrobial Stewardship |
| ID | Term |
|---|---|
| D017723 | Drug Utilization Review |
| D004363 | Drug Utilization |
| D010605 | Pharmacy Administration |
| D009934 | Organization and Administration |
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|
Deaths that occur post-discharge from hospital up to 30 days post-discharge |
| 30 day post-discharge from hospital |
| Readmission to hospital | Readmissions to hospital that occur post-discharge from hospital up to 30 days post-discharge | 30 day post-discharge from hospital |
| D017714 |
| Community-Acquired Infections |
| D006298 | Health Services Administration |
| D014600 | Utilization Review |
| D011787 | Quality of Health Care |
| D011785 | Quality Assurance, Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |