A multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults, the ImpresU trial shows.
In Poland, the Netherlands, Norway, and Sweden, 38 clusters with 1 or more general practices (n = 43) and older adult care organizations (n = 43) were studied during a 5-month baseline period and 7-month follow-up period from Sept. 2019 to June 2021. Clusters randomly received a multifaceted antibiotic stewardship intervention (prescribing decision tool, toolbox with educational materials) or no intervention (usual care).
Changes in the primary outcome of the number of antibiotic prescriptions for suspected urinary tract infections per person-year were as follows for 1,041 frail older adults aged 70 or older (411 person-years): “The numbers of antibiotic prescriptions for suspected urinary tract infections in the follow-up period were 54 prescriptions in 202 person years (0.27 per person year) in the intervention group and 121 prescriptions in 209 person years (0.58 per person year) in the usual care group. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95% confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (<0.01 v 0.05 per person year), hospital referrals (<0.01 v 0.05), admissions to hospital (0.01 v 0.05), and mortality (0 v 0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v 0.26).”