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14 Antibiotic durations can be reduced without risk

 

Even when antibiotic durations are halved, the same good results can be achieved as with the twice-longer, “classic” duration in the treatment of Gram-negative bloodstream infections. This reduction can reduce both side effects and the development of antibiotic resistance.

Portrait / project description (completed research project)

A total of 504 patients hospitalized at any of three centres with a Gram-negative bloodstream infection took part in the study. They were randomly assigned to three groups: the first received 14 days of antibiotics, the second seven days, and the third an individualized duration; the choice of antibiotic was determined by the clinician. Neither the patients nor the doctors knew which group the patients were assigned to until the medication was discontinued. After 30, 60 and 90 days, the effectiveness of the respective treatment duration was evaluated, taking into account any complications and based on the data from the electronic-health record.

Background

In order to avoid unnecessary or harmful antibiotic therapy, it must be selected and implemented according to evidence-based criteria. However, the evidence base is often insufficient. This can be remedied, however, by controlled randomised trials that are carried out in a normal clinical setting using data from the electronic health record. These trials are more efficient than conventional studies and contribute to the introduction of self-learning systems in the health care system.

Aim

The aim of the study was to determine the optimal duration of antibiotic therapy for bloodstream infections in order decrease the emergence of bacterial resistance to antibiotics. For the first time in Switzerland, a point-of-care randomized trial using electronic health data was to be carried out.

Results

This study seeks to avoid over-liberal antibiotic use and its resulting detrimental effects. This will have a positive effect on patients’ health in addition to economic benefits due both to reduced overuse of antibiotics and to shorter hospitalisation. Moreover, the validated IT methodology, with randomisation at the point of care, will be available for use in other research.

Relevance / Application

Significance of the results for research

This point-of-care randomization study design, used for the first time in Switzerland, has created a platform for further studies that allocates patients to intervention and control groups randomly, cost-effectively and using the electronic health record in the normal clinical setting, thus contributing to better use of health resources.

Significance of the results for practice

The study shows that antibiotic durations for Gram-negative bloodstream infections in this patient population with can be reduced without risk.

Original title

The PIRATE project: a Point-of-care, Informatics-based Randomised, controlled trial for decreasing over-utilisation of Antibiotic Therapy in Elderly and comorbid populations

Project leaders

Applicant:

  • Angela Huttner, MD, FMH, Infection Control Program, University Hospitals of Geneva

Co-applicants:

  • Prof. Stephan Harbarth, Service de prévention de l’infection, Faculté de Médecine, Université de Genève
  • Prof. Laurent Kaiser, Laboratoire de Virologie, Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève (HUG)
  • Prof. Pierre-Yves Bochud, Service des Maladies Infectieuses, Département de Médecine Interne, Centre Hospitalier Universitaire Vaudois (CHUV)
  • Dr. Werner Albrich, Infektiologie und Spitalhygiene, Departement Innere Medizin, Kantonsspital St. Gallen

Project partners:

  • Dr. Angèle Gayet-Ageron, Hôpital des enfants, Division d'épidémiologie clinique, Hôpitaux Universitaires de Genève (HUG)
  • Dr. Rodolphe Meyer, Direction des systèmes d'information (DSI), Hôpitaux Universitaires de Genève (HUG)

 

 

Further information on this content

 Contact

Dr. MD Angela Huttner Infection Control Program University Hospitals of Geneva 4, rue Gabrielle-Perret-Gentil 1211 Genève 14 Angela.Huttner@hcuge.ch

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