Antibiotic Use Reports for Infections

(VAST Trial)

Recruiting at 1 trial location

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

8 Participants Needed

Trial Summary

What is the purpose of this trial?

Antimicrobial-resistant and healthcare-associated pathogens are a global health threat. The goals of antimicrobial stewardship are to minimize unnecessary and inappropriate antimicrobial use as a means to combat antimicrobial resistance. Previously, the investigators implemented a Videoconference Antimicrobial Stewardship Team (VAST) at 2 VA Medical Centers (VAMCs), using telehealth to connect clinicians at a rural VAMC to a geographically distant infectious disease expert Both VASTs successfully decreased overall antibiotic use in acute and long-term care units. This project will expand the VAST approach to other VAMCs and test the hypothesis that quarterly reports that quantify facility-level antibiotic use will enhance the efficacy of VASTs to support antimicrobial stewardship. This work will directly increase access to antimicrobial stewardship consultation at rural VA facilities, which are often underserved by infectious disease expertise.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of this treatment for infections?

The research shows that using electronic systems and telemedicine for antimicrobial stewardship can improve the management of antibiotic use. For example, telephonic communication in stewardship programs leads to better acceptance of interventions, and clinical surveillance software helps pharmacists make more effective antibiotic interventions. ^{1 2 3 4 5}

Is the antibiotic use treatment generally safe for humans?

Antimicrobial stewardship programs, which include monitoring for adverse events (unwanted side effects), are important for ensuring the safe use of antibiotics. These programs help track and report any negative effects of antibiotic use, improving patient care and safety. ^{6 7 8 9 10}

How does the Videoconference Antimicrobial Stewardship Team treatment differ from other treatments for infections?

The Videoconference Antimicrobial Stewardship Team treatment is unique because it uses a virtual team to guide and optimize antibiotic use, which can improve the timeliness and appropriateness of therapy compared to traditional methods. This approach leverages technology to provide real-time feedback and decision support, potentially enhancing patient outcomes and reducing unnecessary antibiotic use. ^{1 6 11 12 13}

Research Team

Charlesnika Tyon Evans, PhD MPH BS

Principal Investigator

Edward Hines Jr. VA Hospital, Hines, IL

Robin Lynn Paige Jump, MD PhD

Principal Investigator

VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA

Eligibility Criteria

This trial is for VA medical centers lacking local infectious disease (ID) expertise. These centers will partner with an ID expert from another VA facility to implement the program.

Inclusion Criteria

VA medical centers without their own infectious disease (ID) specialist can partner with another VA medical center that has an ID specialist.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation of the VAST approach at VAMCs, including randomization to VAST- or VAST+ groups

2.25 years

Follow-up

Participants are monitored for safety and effectiveness after implementation

4 weeks

Treatment Details

Interventions

• Quarterly Reports
• Videoconference Antimicrobial Stewardship Team

Trial Overview The study tests if quarterly reports on antibiotic use can improve a telehealth program called VAST, which aims to reduce unnecessary antibiotic prescriptions at rural VA medical centers by connecting them with distant ID experts.

Participant Groups

Group I: VAST+ Experimental Treatment 1 Intervention

Sites that implement the VAST augmented by quarterly facility-level Antibiotic Use Reports (VAST+).

Group II: VAST - Active Control 1 Intervention

to sites that implement the VAST and do NOT receive a quarterly facility-level Antibiotic Use Reports (VAST-).

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

The adaptation of an electronic referral application for antimicrobial stewardship significantly increased the completion rate of antimicrobial round reviews from 59% to 88% over 12 months, indicating improved efficiency in the referral process.

There was a notable reduction in the use of broad-spectrum antibiotics, such as piperacillin/tazobactam and fluoroquinolones, alongside a decrease in the proportion of ignored advice from 18% to 8.5%, demonstrating enhanced adherence to clinical recommendations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. Rawlins, MDM., Raby, E., Sanfilippo, FM., et al.[2022]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital. [2020]

2. England pubmed.ncbi.nlm.nih.gov

Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Method to the madness: Impact of method of contact on intervention acceptance rates for antimicrobial stewardship interventions. [2021]

4. Canada pubmed.ncbi.nlm.nih.gov

Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Social dynamics of a population-level dashboard for antimicrobial stewardship: A qualitative analysis. [2022]

7. England pubmed.ncbi.nlm.nih.gov

A framework for implementing antibiotic stewardship in ambulatory care: Lessons learned from the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

New thoughts on the "forgotten" aspect of antimicrobial stewardship: adverse event reporting. [2015]

9. United States pubmed.ncbi.nlm.nih.gov

Core Elements of Outpatient Antibiotic Stewardship. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Promoting antimicrobial stewardship: using video tools for junior doctors' induction. [2015]

11. United States pubmed.ncbi.nlm.nih.gov

Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009-2010: A Pragmatic Retrospective Observational Study. [2022]

12. Canada pubmed.ncbi.nlm.nih.gov

Surveillance Software and Prospective Audit and Feedback Rounds Advance Antimicrobial Stewardship at an Acute Care Community Hospital. [2018]

13. England pubmed.ncbi.nlm.nih.gov

The impact of a multidisciplinary antimicrobial stewardship team on the timeliness of antimicrobial therapy in patients with positive blood cultures: a randomized controlled trial. [2017]