Antibiotic Use in French Nursing Home

NCT03180983 | Unknown

• 1 other identifier: Prot_ATOUM4_V1
• Study Type: interventional
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief Summary

CONTEXT: France is still one of the biggest consumers of antibiotics in Europe. An explanation for this increase in consumption would be aging. Thus, part of this aging population lives in nursing home, where the urinary tract infection is the second most suspected pathology. However, it can most often be bacteriuria requiring no antibiotic therapy. In nursing home, nurses who alert prescribers when an infection is suspected by describing clinical signs.However, his propensity to perform too rapidly and systematically an examination with dipsticks leads the physician to prescribe antibiotic. This is how a program called ATOUM is set up to reduce the prescription of antibiotics in nursing home. The present ATOUM 4 study builds on this program. OBJECTIVE: To measure the effect of a nurse-centered multimodal intervention involving training and sensitization on urinary tract infection, asymptomatic bacteriuria, antibiotic resistance and interprofessional communication on antibiotic therapy. METHODS: This will be a randomized double-arm interventional study in 40 nursing home. The intervention group of 20 nursing home will receive a blended-learning intervention.

Conditions

Antibiotic Resistant Infection

Outcome Measures

Primary Outcomes (1)

• Antibiotics prescription for UTI

  The percentage of reduction in prescriptions of antibiotics for urinary tract infection

  Twelve months

Secondary Outcomes (1)

• Total prescriptions of antibiotics

  Twelve months

Study Arms (2)

INTERVENTIONAL GROUP

OTHER

The intervention group will receive a blended-learning intervention.

Behavioral: multimodal intervention

CONTROL GROUP

NO INTERVENTION

No intervention

Interventions

multimodal intervention BEHAVIORAL

Investigators will propose an online training. In addition, investigators will make phone calls to nursing home interlocutor between two nursing home visits. The tools of this intervention will consist on posters , quiz about bacteriuria and urinary tract infection (UTI) and algorithm to help nurse's reasoning when UTI is suspected.

INTERVENTIONAL GROUP

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• nursing home with registred nursing
• Presence of prescription registration system
• Situated in Paris and surb of Paris

You may not qualify if:

• n/a

Sponsors & Collaborators

• University of Paris 13: lead

Related Publications (8)

• Franchi C, Tettamanti M, Pasina L, Djignefa CD, Fortino I, Bortolotti A, Merlino L, Nobili A. Changes in drug prescribing to Italian community-dwelling elderly people: the EPIFARM-Elderly Project 2000-2010. Eur J Clin Pharmacol. 2014 Apr;70(4):437-43. doi: 10.1007/s00228-013-1621-6. Epub 2014 Jan 8.

  PMID: 24398968 BACKGROUND

• Moreira VG, Lourenco RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study. Clinics (Sao Paulo). 2013 Jul;68(7):979-85. doi: 10.6061/clinics/2013(07)15.

  PMID: 23917663 BACKGROUND

• Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K; Society for Healthcare Epidemiology of America (SHEA); Association for Professionals in Infection Control and Epidemiology (APIC). SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control. 2008 Sep;36(7):504-35. doi: 10.1016/j.ajic.2008.06.001. No abstract available.

  PMID: 18786461 BACKGROUND

• Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K; SHEA; APIC. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol. 2008 Sep;29(9):785-814. doi: 10.1086/592416. No abstract available.

  PMID: 18767983 BACKGROUND

• Marston HD, Dixon DM, Knisely JM, Palmore TN, Fauci AS. Antimicrobial Resistance. JAMA. 2016 Sep 20;316(11):1193-1204. doi: 10.1001/jama.2016.11764.

  PMID: 27654605 BACKGROUND

• Phillips CD, Adepoju O, Stone N, Moudouni DK, Nwaiwu O, Zhao H, Frentzel E, Mehr D, Garfinkel S. Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes. BMC Geriatr. 2012 Nov 23;12:73. doi: 10.1186/1471-2318-12-73.

  PMID: 23176555 BACKGROUND

• Chami K, Gavazzi G, Carrat F, de Wazieres B, Lejeune B, Piette F, Rothan-Tondeur M. Burden of infections among 44,869 elderly in nursing homes: a cross-sectional cluster nationwide survey. J Hosp Infect. 2011 Nov;79(3):254-9. doi: 10.1016/j.jhin.2011.08.003. Epub 2011 Sep 6.

  PMID: 21899920 BACKGROUND

• Inkster T, Marek A, Khanna N. Improving antimicrobial prescribing by targeting clinical nurse practitioners. J Hosp Infect. 2010 Sep;76(1):85-6. doi: 10.1016/j.jhin.2010.05.009. No abstract available.

  PMID: 20663586 BACKGROUND

Related Links

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Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of nursing research chair

Model Details: CLUSTER RANDOMIZED STUDY

Study Record Dates

• First Submitted: June 1, 2017
• First Posted: June 8, 2017
• Study Start: March 1, 2019
• Primary Completion: March 1, 2020
• Study Completion: March 30, 2020
• Last Updated: January 8, 2019

Record last verified: 2019-01

Data Sharing

• IPD Sharing: Will not share