Grant: Project Grant - PA: ECR Antimicrobial Resistance Multi-Year Grant

Antibiotic resistance is one of the greatest public health challenges of our time. Antibiotic use is thought to be a major driver of antibiotic resistance. However, as antibiotic resistance increases, it becomes more difficult to provide adequate empiric antibiotic therapy, particularly in patients with severe infection (sepsis). Individualized prescribing decision support could help reduce the use of broad-spectrum antibiotic therapy while maintaining or improving adequacy of therapy. We have developed and piloted clinical decision support tools for prescribing antibiotics in patients with suspected infection. We need to determine whether these tools reduce unnecessary prescribing and improve therapy in one of the most common indications for antibiotic use in hospitals, empiric treatment of sepsis. We will perform a cluster randomized cross-over trial of an individualized antibiotic prescribing decision support intervention for providers treating hospitalized patients with suspected sepsis. We hypothesize that this intervention will improve the number of patients receiving early de-escalation from broad-spectrum empiric therapy while maintaining or improving time to adequate therapy. Across three health centres we will randomize 18 medical, critical care, and surgical service groups to a stewardship pharmacist-facilitated intervention providing decision support for antibiotic treatment in early sepsis. Our primary outcome will be the de-escalation of patient's antibiotics from their initial regimen, occurring within 48 hours of initial receipt of antibiotics. This study will provide evidence for the use of individualized decision support for treating patients with sepsis, with anticipated reductions in broad-spectrum antibiotic use and time to adequate treatment. If successful, the results of this study will inform the generalizability of this approach for broader adoption, and lay the groundwork for integration into electronic decision support structures.