一款智能手机应用程序对三家三级医院合理使用抗生素的影响：一项国际多中心阶梯楔形整群随机试验
Impact of a smartphone application for appropriate antibiotic prescribing at three tertiary hospitals: an international, multicentre stepped-wedge cluster randomized trial.
作者信息
Helou Ramzy I, Catho Gaud, Faxén Lisa, Hulscher Marlies, Teerenstra Steven, Conly John, Huttner Benedikt D, Tängdén Thomas, Verbon Annelies
机构信息
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands.
Division of Infectious Diseases, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Division, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland.
出版信息
Clin Microbiol Infect. 2025 Jul;31(7):1172-1179. doi: 10.1016/j.cmi.2025.02.026. Epub 2025 Mar 1.
OBJECTIVES
Smartphone applications (apps) for antibiotic prescribing have been studied in observational studies. Here, we assessed whether the use of a smartphone app increased appropriate antibiotic therapy (AAT) in hospitals.
METHODS
An antibiotic stewardship app (Firstline.org) was populated with local guidelines and tested in a stepped-wedged cluster randomized trial in three hospitals in the Netherlands, Sweden, and Switzerland. Defined clusters were randomized per hospital for the intervention (use of app) or standard of care. Primary outcome was AAT assessed by chart review in 15 random patients per cluster per intervention period. Secondary outcomes included clinical outcomes and user analytics. A questionnaire identifying barriers to app use was disseminated. Multivariable multilevel logistic models with time periods as fixed effects to adjust for time trend and treatment as fixed effects were employed to estimate the odds ratio of treatment.
RESULTS
Twelve clusters in the Netherlands (1085 patients) were included, 12 in Sweden (362 patients) and 8 in Switzerland (653 patients). Overall, AAT was not increased (2.0% [95% CI, -5.92% to 9.97%]) in the intervention arm compared with control across the three centres. Mean frequency of app use by cluster was associated with an AAT increase (1.9% [95% CI, 1.18-2.62%]) across study centres; 3.2% in the Netherlands (p < 0.01), 2.8% in Switzerland (p < 0.01), and remained similar in Sweden (0.4%; p 0.46). No difference was found for the other secondary outcomes. Main barriers for app use reported in the questionnaire were easily forgetting using the app and having other tools to help prescribing antibiotics.
DISCUSSION
Overall, the introduction of a stewardship app did not significantly increase AAT, but a prespecified secondary analysis of app use frequency was associated with a small but significant improvement of AAT. Variable uptake of the app, coexisting routes to guidelines and the impact of the COVID-19 pandemic during the trial likely had an impact on the results.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov, trial number NCT03793946.
目的
在观察性研究中已对用于抗生素处方的智能手机应用程序（应用）进行了研究。在此，我们评估了在医院中使用智能手机应用是否能增加适当的抗生素治疗（AAT）。
方法
一个抗生素管理应用程序（Firstline.org）被植入当地指南，并在荷兰、瑞典和瑞士的三家医院进行的阶梯楔形整群随机试验中进行测试。每个医院将定义的群组随机分为干预组（使用应用程序）或对照组（标准治疗）。主要结局是通过在每个干预期对每个群组的15名随机患者进行病历审查来评估AAT。次要结局包括临床结局和用户分析。分发了一份识别应用程序使用障碍的问卷。采用以时间段为固定效应来调整时间趋势、以治疗为固定效应的多变量多水平逻辑模型来估计治疗的优势比。
结果
纳入了荷兰的12个群组（1085例患者）、瑞典的12个群组（362例患者）和瑞士的8个群组（653例患者）。总体而言，与三个中心的对照组相比，干预组的AAT没有增加（2.0% [95% CI，-5.92%至9.97%]）。各群组应用程序的平均使用频率与整个研究中心AAT的增加相关（1.9% [95% CI，1.18 - 2.62%]）；荷兰为3.2%（p < 0.01），瑞士为2.8%（p < 0.01），瑞典保持相似（0.4%；p = 0.46）。在其他次要结局方面未发现差异。问卷中报告的应用程序使用的主要障碍是容易忘记使用应用程序以及有其他帮助抗生素处方的工具。
讨论
总体而言，引入管理应用程序并未显著增加AAT，但对应用程序使用频率的预先指定的次要分析与AAT的小幅但显著改善相关。应用程序的不同采用情况、指南的共存途径以及试验期间COVID - 19大流行的影响可能对结果产生了影响。
试验注册号
ClinicalTrials.gov，试验编号NCT03793946。
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