The impact of a Virtual Antimicrobial stewardship Team (VAT) on antibiotic prescriptions in Dutch nursing homes: a protocol for a randomised controlled trial

Abstract

Abstract Background Inappropriate prescribing of antibiotics for suspected urinary tract infections (UTI), respiratory tract infections (RTI) and skin and soft tissue infections (SSTI) in nursing homes (NHs) is common. Antimicrobial stewardship (AMS) has proven effectiveness in reducing inappropriate antibiotic prescriptions in hospitals. As the effectiveness of AMS has not yet been demonstrated in NHs, AMS has not yet been widely adopted in NHs. Therefore, the aim of this study is to evaluate the effect of a virtual antimicrobial stewardship team (VAT) on inappropriate antibiotic prescribing in NHs. An additional aim is to determine internal and external validity and identify barriers and facilitators of implementing VAT. Methods This study is a multicentre, two-arm, randomised, controlled, non-blinded trial to evaluate a VAT intervention in Dutch NHs. Four Medical Microbiology Laboratories (MMLs) and seven NHs will collaborate in this study, with in total 54 clinicians (27 per arm). Clinicians will be randomly assigned to either VAT (intervention) or usual care (control) in a 1:1 ratio. The clinicians in the intervention group will participate in a weekly VAT meeting for 36 weeks. The primary outcome is the incidence rate of inappropriate antibiotic prescriptions per clinician per week. The sample size is sufficient to demonstrate a reduction of 35% in the incidence rate of inappropriate prescriptions, with a power of 90% at alpha of 0.05. Secondary outcomes are the incidence rate (IR) of total antibiotic prescriptions, and the internal and external validity, and facilitators and barriers to VAT implementation through process evaluation. Discussion This protocol describes an RCT to evaluate whether an AMS intervention in Dutch NHs results in a reduction in the incidence rate of inappropriate antibiotic prescriptions for UTI, RTI and SSTI. A potential limitation is that researchers and clinicians cannot be blinded due to the nature of the intervention and there is risk of contamination between the intervention and control arm, as clinicians working in the same NH may be randomised to different arms; this may dilute the observed effect of the intervention. Trial registration ClinicalTrials.gov Identifier: NCT05998226