Antibiotic Outbreak, Risk Factors for Never Event, Prediction of Inappropriate Use

Infectious Disease Clinical Trial

Official title:

A Retrospective Study to Understand the Risk Factors/Drivers of "Inappropriate" Antimicrobial Use and the Performance Evaluation of a Clinical Decision Support Tool That Facilitates Prediction of Outbreaks of Inappropriate Antibiotic Use

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03489330
• Other study ID #: MWU3004_STU00205629
• Status: Completed
• Start date: January 1, 2014
• Est. completion date: December 29, 2020

Study information

• Verified date: March 2021
• Source: Midwestern University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

In order to decrease inappropriate antibiotic use, drivers of inappropriate use must be identified locally. This study will focus on the MOST inappropriate use, which are defined as 'never events'. Previous work has shown that antibiotic use clusters over time. It is hypothesized that never events also cluster over time. Using electronic data capture strategies, an algorithm will be developed to quickly and accurately identify areas of antibiotic use concern. Secondly, a framework will be developed, utilizing antimicrobial consumption data and captured signals of inappropriate antimicrobial use to provide targets for antimicrobial stewardship efforts.

Description:

Appropriateness in antimicrobial prescribing has become a focal national and international issue. It has been estimated that upwards of 50% of antibiotic use is inappropriate. With this backdrop, a national strategic goal has been set by the United States White House to decrease inappropriate antibiotic use by 20% and 50%, respectively for inpatient and outpatient settings. In order to decrease inappropriate use, drivers of incorrect use must be identified at each local setting. The actual drivers of confirmed inappropriate use have been difficult to identify except when using time and resource intense chart reviews. Even the largest contemporary antibiotic consumption studies have not assessed appropriateness as it was 'outside of study scope'. Further, there is no consensus or agreement on what constitutes inappropriate use. These apparent omissions underscore the difficulty and complexity in attributing appropriateness of use for antimicrobials. Importantly, this study will focus on the MOST inappropriate use, which are defined as 'never events'. Previous work has shown that antibiotic use clusters over time. It is hypothesized that never events also cluster over time. Using electronic data capture strategies, an algorithm will be developed to quickly and accurately identify areas of antibiotic use concern. Secondly, a framework will be developed, utilizing antimicrobial consumption data and captured signals of inappropriate antimicrobial use to provide targets for antimicrobial stewardship efforts.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2000
• Est. completion date: December 29, 2020
• Est. primary completion date: October 1, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 90 Years

Eligibility

Inclusion Criteria:

• receipt of inpatient intravenous vancomycin during proposed study period

• adults 18 years of age or older and less than 90 years of age

Exclusion Criteria:

• individuals who are not yet adults (infants, children, teenagers)

• pregnant women

• prisoners

Related Conditions & MeSH terms

• Communicable Diseases
• Infection
• Infectious Disease

Locations

Country	Name	City	State
United States	Midwestern University	Downers Grove	Illinois

Sponsors (5)

Lead Sponsor	Collaborator
Midwestern University	Henry Ford Hospital, Northwestern Memorial Hospital, University of Michigan, Wayne State University

Country where clinical trial is conducted

United States, 

References & Publications (13)

Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012. JAMA Intern Med. 2016 Nov 1;176(11):1639-1648. doi: 10.1001/jamainternmed.2016.5651. — View Citation

Cusini A, Rampini SK, Bansal V, Ledergerber B, Kuster SP, Ruef C, Weber R. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey. PLoS One. 2010 Nov 16;5(11):e14011. doi: 10.1371/journal.pone.0014011. — View Citation

Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R, Margolis DJ, May LS, Merenstein D, Metlay JP, Newland JG, Piccirillo JF, Roberts RM, Sanchez GV, Suda KJ, Thomas A, Woo TM, Zetts RM, Hicks LA. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011. JAMA. 2016 May 3;315(17):1864-73. doi: 10.1001/jama.2016.4151. — View Citation

Glowacki RC, Schwartz DN, Itokazu GS, Wisniewski MF, Kieszkowski P, Weinstein RA. Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance. Clin Infect Dis. 2003 Jul 1;37(1):59-64. Epub 2003 Jun 23. — View Citation

Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med. 2003 Apr 28;163(8):972-8. — View Citation

Kelesidis T, Braykov N, Uslan DZ, Morgan DJ, Gandra S, Johannsson B, Schweizer ML, Weisenberg SA, Young H, Cantey J, Perencevich E, Septimus E, Srinivasan A, Laxminarayan R. Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009-2010: A Pragmatic Retrospective Observational Study. Infect Control Hosp Epidemiol. 2016 Jan;37(1):70-9. doi: 10.1017/ice.2015.226. Epub 2015 Oct 12. — View Citation

Magill SS, Edwards JR, Beldavs ZG, Dumyati G, Janelle SJ, Kainer MA, Lynfield R, Nadle J, Neuhauser MM, Ray SM, Richards K, Rodriguez R, Thompson DL, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014 Oct 8;312(14):1438-46. doi: 10.1001/jama.2014.12923. — View Citation

P.R. Yarnold, R.C. Soltysik, Maximizing Predictive Accuracy, ODA Books2016.

P.R. Yarnold, R.C. Soltysik, Refining two-group multivariable classification models using univariate optimal discriminant analysis., Decision Sciences, 22 (1991) 1158-1164.

Rhodes NJ, O'Donnell JN, Lizza BD, McLaughlin MM, Esterly JS, Scheetz MH. Tree-Based Models for Predicting Mortality in Gram-Negative Bacteremia: Avoid Putting the CART before the Horse. Antimicrob Agents Chemother. 2015 Nov 23;60(2):838-44. doi: 10.1128/AAC.01564-15. Print 2016 Feb. — View Citation

Rhodes NJ, Wagner JL, Gilbert EM, Crew PE, Davis SL, Scheetz MH. Days of Therapy and Antimicrobial Days: Similarities and Differences Between Consumption Metrics. Infect Control Hosp Epidemiol. 2016 Aug;37(8):971-3. doi: 10.1017/ice.2016.109. Epub 2016 May 13. — View Citation

Scheetz MH, Crew PE, Miglis C, Gilbert EM, Sutton SH, O'Donnell JN, Postelnick M, Zembower T, Rhodes NJ. Investigating the Extremes of Antibiotic Use with an Epidemiologic Framework. Antimicrob Agents Chemother. 2016 May 23;60(6):3265-9. doi: 10.1128/AAC.00572-16. Print 2016 Jun. — View Citation

The World Health Organization. Health Topics: Disease Outbreaks, 2015.

* Note: There are 13 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	appropriateness of vancomycin use	classified as 1) never event, 2) potentially inappropriate, 3) not inappropriate	Proposed 36 month study period
Secondary	outbreaks of never events	predictive interval thresholds that identify high proportion of never events	Proposed 36 month study period

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