APEMAC, Université de Lorraine, Nancy, France
Service d'odontologie, CHRU de Nancy, Nancy, France.
BMJ Open. 2022 Apr 5;12(4):e056125. doi: 10.1136/bmjopen-2021-056125.
Antibiotic resistance is one of the most pressing health threats that mankind faces now and in the coming decades. Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality. In order to tackle antibiotic resistance, we will implement in our tertiary care university hospital a computerised-decision support system (CDSS) facilitating antibiotic stewardship and an electronic surveillance software (ESS) facilitating infection prevention and control activities. We describe the protocol to evaluate the impact of the CDSS/ESS combination in adult inpatients.
We conduct a pragmatic, prospective, single-centre, before-after uncontrolled study with an interrupted time-series analysis 12 months before and 12 months after the introduction of the CDSS for antibiotic stewardship (APSS) and ESS for infection surveillance (ZINC). APSS and ZINC will assist, respectively, the antibiotic stewardship and the infection prevention and control teams of Nancy University Hospital (France). We will evaluate the impact of the CDSS/ESS on the antibiotic use in adult (≥18 years) inpatients (hospitalised ≥48 hours). The primary outcome is the prescription rate by all healthcare professionals from the hospital of all systemic antibiotics expressed in defined daily doses/1000 patients/month. Concurrently, we will assess the safety of the intervention, its impact on the appropriateness of antibiotic prescriptions and on additional precautions (isolation precautions) as recommended in guidelines, and on bacterial epidemiology (multidrug-resistant bacteria and infections) in the hospital. Finally, we will evaluate the users' satisfaction and the cost of this intervention from the hospital perspective.
The protocol has been approved by the Ethics Committee of Nancy University Hospital and registered on the ClinicalTrials platform. Results will be disseminated through conferences' presentations and publications in peer-reviewed journals.
NCT04976829.
抗生素耐药性是人类现在和未来几十年面临的最紧迫的健康威胁之一。抗生素耐药性导致住院时间延长、医疗费用增加和死亡率上升。为了应对抗生素耐药性，我们将在我们的三级保健大学医院实施一个计算机化决策支持系统（CDSS），以促进抗生素管理，并实施一个电子监测软件（ESS），以促进感染预防和控制活动。我们描述了评估 CDSS/ESS 组合对成年住院患者影响的方案。
我们进行了一项实用的、前瞻性的、单中心、前后对照、无对照研究，采用中断时间序列分析，在引入抗生素管理的 CDSS（APSS）和感染监测的 ESS（ZINC）之前和之后各进行 12 个月。APSS 和 ZINC 将分别协助南锡大学医院（法国）的抗生素管理和感染预防与控制团队。我们将评估 CDSS/ESS 对成年（≥18 岁）住院患者（住院时间≥48 小时）抗生素使用的影响。主要结果是所有医疗保健专业人员在医院开出的所有全身抗生素的处方率，以每 1000 名患者/月的限定日剂量表示。同时，我们将评估干预措施的安全性、对抗生素处方适宜性的影响以及对指南推荐的额外预防措施（隔离预防措施）的影响，并评估医院内的细菌流行病学（多药耐药菌和感染）。最后，我们将从医院的角度评估用户的满意度和干预措施的成本。
该方案已获得南锡大学医院伦理委员会的批准，并在 ClinicalTrials 平台上注册。结果将通过会议报告和同行评议期刊上的出版物进行传播。
NCT04976829。
