VAT-2: Evaluation of a Virtual Antimicrobial Stewardship Team (VAT) on Antibiotic Prescriptions in Nursing Homes

NCT05998226 | Completed

• 1 other identifier: W23_041 #23.064
• Study Type: interventional
• Target: 57
• Locations: 1 country
• Sites: 1

Brief Summary

The Virtual Antimicrobial stewardship Team (VAT) study aims to evaluate, in a randomized controlled trial (RCT), the effect of a weekly virtual antimicrobial stewardship (AMS) intervention on the appropriateness of prescribing antibiotics for nursing home (NH) residents with urinary tract infections (UTI), respiratory tract infections (RTI) or skin and soft tissue infections (SSTI) compared to standard care for NH residents in Dutch NHs in the provinces of North-Holland and Flevoland. The secondary aim is to identify barriers and facilitators to implement a stewardship intervention and subsequently develop an implementation guide.

Conditions

Bacterial Infections

Outcome Measures

Primary Outcomes (1)

• Inappropriate antibiotic prescriptions

  The proportion of inappropriate antibiotic prescriptions in the intervention group compared to the control group (standard of care) according to the current guidelines algorithm.

  9 months

Secondary Outcomes (3)

• Incidence rate (IR)

  9 months

• Barriers and facilitators

  9 months

• Barriers and facilitators

  9 months

Study Arms (2)

Standard care (control group)

NO INTERVENTION

The clinicians from the control arm do not participate in VAT meetings. The antibiotic prescriptions prescribed by clinicians in the control group are extracted from the prescription system after the study period. Two researchers independently extract the data from patient files, including any culture results, and assess the antibiotic use based on the algorithm from the current guidelines that are used in NHs.

Virtual Antimicrobial stewardship Team (VAT) (intervention group)

EXPERIMENTAL

The VAT consists at least of a medical microbiologist and a clinician from the NH. Depending on the NH organization concerned and cooperation agreements, a pharmacist will or will not be involved. They conduct weekly consultations during 9 months to evaluate the antibiotic prescriptions of the clinician based on algorithms from current guidelines in use in the NH. This is an evaluation of standard care .

Other: Virtual Antimicrobial stewardship Team (VAT)

Interventions

Virtual Antimicrobial stewardship Team (VAT) OTHER

The VAT consists of at least a clinical microbiologist and a clinician from the NH. Ideally, a pharmacist will also attend. They conduct a weekly (digital) meeting for nine months to evaluate the antibiotic prescriptions of the clinician attending the VAT meeting, based on a standardized protocol according to the current national infection treatment guidelines.

Virtual Antimicrobial stewardship Team (VAT) (intervention group)

Eligibility Criteria

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

You may qualify if:

• Working in nursing homes in the North Holland-Flevoland region and being authorized to prescribe.
• Agreeing to being randomized to intervention or control group.
• Working in a nursing home that has a medication prescription system from which prescriptions can easily be obtained for VAT meetings.
• Working in a nursing home that is connected to a microbiology lab, .that participates in this study and offers VAT meetings.
• Expected to be employed for at least four months from date of randomization.
• All prescriptions for antibiotics with a therapeutic indication regarding urinary tract infections, respiratory tract infections or skin and soft tissue infections for residents of nursing homes, prescribed by clinicians participating in the study, during the study period.

You may not qualify if:

• Prescriptions for antibiotics with a prophylactic purpose.
• Prescriptions given by clinicians not participating in the study
• Prescriptions prescribed outside the study period.

Sponsors & Collaborators

• Public Health Service of Amsterdam: lead
• Amsterdam University Medical Centers (UMC), Location Academic Medical Center (AMC): collaborator

Study Sites (1)

Public Health Service of Amsterdam

Amsterdam, North Holland, 1018WT, Netherlands

Location

Related Publications (1)

• Paap KC, Kolodziej LM, van Buul LW, de Jong MD, van der Loeff MFS, Kuil SD. The impact of a weekly antimicrobial stewardship team intervention on antibiotic prescriptions in Dutch nursing homes: a protocol for a randomised controlled trial. Trials. 2025 Dec 29;26(1):587. doi: 10.1186/s13063-025-09303-w.

  PMID: 41462319 DERIVED

MeSH Terms

Conditions

Bacterial Infections

Condition Hierarchy (Ancestors)

Bacterial Infections and Mycoses; Infections

Study Officials

• Maarten MF Schim van der Loeff, Prof. dr.

  Public Health Service of Amsterdam

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: The investigators will conduct a multi-center, two-arm, randomized controlled trial to evaluate a virtual antibiotic stewardship team (VAT) compared to standard care in Dutch NHs. After assessment of eligibility, the participants (clinicians) in the study are randomized (1:1) to the standard of care arm or to the intervention arm (weekly VAT meeting for 9 months). Randomization will be done stratified on the basis of function (group 1. elderly care physicians, group 2. physicians in training to become a specialist/ other physicians, group 3. nurse practitioners/ physician assistants).

Study Record Dates

• First Submitted: August 1, 2023
• First Posted: August 18, 2023
• Study Start: July 1, 2023
• Primary Completion: December 31, 2024
• Study Completion: December 31, 2024
• Last Updated: February 6, 2025

Record last verified: 2025-02

Data Sharing

• IPD Sharing: Will not share

Locations

NL (1)