ImpresU
Trial question
What is the role of multifaceted antibiotic stewardship intervention in frail older adults with suspected UTIs?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
71.0% female
29.0% male
N = 1041
1041 patients (738 female, 303 male).
Inclusion criteria: frail older patients aged ≥ 70 years.
Key exclusion criteria: participation for < 2 months; in hospice-care; limited life expectancy of ≤ 1 month; on antibiotic prophylaxis.
Interventions
N=502 antibiotic stewardship intervention (participatory-action-research approach used for implementation, with sessions for education, evaluation, and local tailoring of the intervention).
N=539 usual care (no intervention).
Primary outcome
Number of antibiotic prescriptions for suspected urinary tract infections
0.27 / p-y
0.58 / p-y
0.6/ p-y
0.4/ p-y
0.3/ p-y
0.1/ p-y
0.0/ p-y
Antibiotic stewardship
intervention
Usual
care
Significant
decrease ▼
Significant decrease in the number of antibiotic prescriptions for suspected UTIs (0.27/ p-y vs. 0.58/ p-y; RR 0.42, 95% CI 0.26 to 0.68).
Secondary outcomes
Significant decrease in antibiotic prescriptions in office hours on day of suspected UTI (0.19/ p-y vs. 0.36/ p-y; RR 0.33, 95% CI 0.19 to 0.57).
Significant decrease in suspected UTIs (0.32/ p-y vs. 0.72/ p-y; RR 0.51, 95% CI 0.34 to 0.77).
No significant difference in all-cause mortality (0.26/ p-y vs. 0.26/ p-y; RR 1.03, 95% CI 0.48 to 2.21).
Conclusion
In frail older patients aged ≥ 70 years, antibiotic stewardship intervention was superior to usual care with respect to number of antibiotic prescriptions for suspected UTIs.
Reference
Esther A R Hartman, Alma C van de Pol, Silje Rebekka Heltveit-Olsen et al. Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries. BMJ. 2023 Feb 22;380:e072319.
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