Developing a novel antibiogram tool to improve empiric antibiotic prescribing in nursing homes

开发新型抗菌谱工具以改善疗养院的经验性抗生素处方

• 批准号: 10099724
• 负责人: Christopher J Crnich
• 金额: $ 49.95万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10099724
• 关键词: Developing; novel; antibiogram; tool; improve

PROJECT SUMMARY/ABSTRACT Inappropriate antibiotic use is a common problem that contributes to adverse drug events and antibiotic resistance in nursing homes (NHs). Empiric antibiotic selection decisions in NHs are frequently suboptimal. Cumulative susceptibility reports based on patient cultures, known as antibiograms, are tools increasingly being used to improve empiric antibiotic decisions in NHs. However, most NHs collect an insufficient number of cultures to permit creation of reliable facility-specific antibiograms causing many facilities to turn to pooled facility antibiograms. Antibiograms based on combining culture data from multiple facilities improve the reliability of reported susceptibility estimates and accurately reflect regional antibiotic resistance patterns but may present a distorted picture of susceptibility patterns at the local level. Consequently, it is possible that increasing use of pooled facility antibiograms may worsen rather than improve empiric antibiotic decisions in NHs. The weighted-incidence syndromic combination antibiogram (WISCA) is a novel method that makes better use of available microbiology data when culture results are scarce. A WISCA also presents data in a manner that may reduce cognitive load on clinicians. We believe WISCAs will prove to be more reliable than traditional antibiograms and exert a greater effect on empiric antibiotic decisions in NHs. The objectives of this study are to develop a user-friendly WISCA tool, compare it to a traditional antibiogram and develop a toolkit for its implementation and evaluation in NHs. We will achieve these objectives through the following specific aims: In Aim 1, we will conduct a prospective surveillance study in 82 NHs in four states to characterize antibiotic susceptibility patterns in NHs using traditional antibiograms and WISCAs. Existing study NH culture data will be obtained from their reference laboratories. The reliability of the two antibiogram formats will be evaluated and the congruence between single and pooled facility susceptibility estimates will be estimated. In Aim 2, we will develop a user-friendly WISCA format with input from NH clinicians. The resulting tool will be evaluated using a simulated case-study approach in which 300 NH clinicians will be asked to complete several clinical vignettes describing common NH urinary syndromes. Participants will be randomized to complete the vignettes using either clinical information alone or with the assistance of a pooled antibiogram or a WISCA tool. Appropriateness of antibiotic decisions will be compared across the three study arms. In Aim 3, we will perform a facilitated implementation pilot study in 6-10 NHs in order to develop a toolkit for implementing and evaluating the WISCA intervention. We will use a mixed-methods approach, structured around the SEIPS model and Theoretical Domains Framework, to identify implementation barriers and enablers in study NHs and to identify and design strategies to enhance adoption of the WISCA intervention. Outcomes from this work will be used to develop a large-scale pragmatic clinical trial to assess the effects the WISCA has on antibiotic decisions in a real clinical practice environment.

项目概要/摘要 抗生素使用不当是导致药物不良事件和抗生素不良事件的一个常见问题 疗养院（NH）中的阻力。 NH 中的经验性抗生素选择决策常常不是最理想的。 基于患者培养物的累积敏感性报告（称为抗菌谱）是越来越多的工具 用于改善 NH 的经验性抗生素决策。然而，大多数 NH 收集的培养物数量不足 允许创建可靠的设施特定抗菌谱，导致许多设施转向联合设施 抗菌谱。基于结合多个设施的培养数据的抗菌谱提高了可靠性 报告的敏感性估计值并准确反映区域抗生素耐药性模式，但可能会出现 地方层面易感性模式的扭曲图景。因此，有可能增加使用 综合设施抗菌谱可能会恶化而非改善 NH 的经验性抗生素决策。 加权发病率综合征组合抗菌谱（WISCA）是一种更好利用的新方法 当培养结果缺乏时可用的微生物学数据。 WISCA 还以以下方式呈现数据： 可以减轻临床医生的认知负担。我们相信 WISCA 将比传统的更可靠 抗生素谱并对 NH 中的经验性抗生素决策产生更大影响。本研究的目的是 开发一个用户友好的 WISCA 工具，将其与传统的抗菌谱进行比较，并为其开发一个工具包 在NH 中的实施和评估。我们将通过以下具体目标来实现这些目标： 在目标 1 中，我们将在四个州的 82 个 NH 中进行前瞻性监测研究，以表征抗生素 使用传统抗菌谱和 WISCA 确定 NH 的敏感性模式。现有研究 NH 培养数据将 从他们的参考实验室获得。将评估两种抗菌谱格式的可靠性并 将估计单一设施和联合设施敏感性估计值之间的一致性。 在目标 2 中，我们将根据 NH 临床医生的意见开发一种用户友好的 WISCA 格式。由此产生的工具将是 使用模拟案例研究方法进行评估，其中 300 名 NH 临床医生将被要求完成多项任务 描述常见 NH 泌尿系统综合症的临床片段。参与者将被随机分配来完成 单独使用临床信息或在汇总抗菌谱或 WISCA 工具的帮助下进行的小插图。 将在三个研究组之间比较抗生素决策的适当性。 在目标 3 中，我们将在 6-10 个国家/地区开展一项促进实施试点研究，以便开发一个工具包 实施和评估 WISCA 干预措施。我们将使用混合方法，围绕 SEIPS 模型和理论领域框架，以确定研究中的实施障碍和推动因素 NH 并确定和设计策略以加强 WISCA 干预措施的采用。由此产生的结果 工作将用于开展大规模实用临床试验，以评估 WISCA 对 在真实的临床实践环境中做出抗生素决策。