Antimicrobial Use and Stewardship in an Outpatient Hemodialysis Unit
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ClinicalTrials.gov Identifier: NCT03172039
Recruitment Status :
First Posted : June 1, 2017
Last Update Posted : October 26, 2017
University Health Network, Toronto
Information provided by (Responsible Party):
Marisa Battistella, University Health Network, Toronto
This quality improvement study will assess the antimicrobial use and prescribing practices of hospital and community prescribers for the ambulatory hemodialysis (HD) population in an urban academic outpatient HD unit in Ontario. Currently, in the outpatient HD unit at Toronto General Hospital (TGH), it is the standard of care for the patients to be screened on a weekly basis by the nephrology care team for the use of any oral or intravenous antimicrobials. Patient charts, pharmacy patient profiles and electronic medical records for these patients from September 1 2016 - April 30 2017 will be retrospectively reviewed in order to characterize antimicrobial use and its concordance with available clinical guidelines and antimicrobial stewardship principles described by the Centers for Disease Control and Prevention (CDC). The primary objective of the study is to determine the prevalence of antimicrobial use in an ambulatory HD population. The secondary objective of the study is to determine the congruence of prescribed antimicrobial regimens with available clinical guidelines and antimicrobial stewardship principles described by the CDC. It is hypothesized that antimicrobial use among HD patients will be common and that antimicrobial prescribing practices are not congruent with recommendations from published clinical guidelines and antimicrobial stewardship principles for a significant proportion of patients included in the retrospective review. Descriptive analysis of the data will summarize the findings. Future research will build upon the results of this project, and may include the development of interventions that target gaps in knowledge and prescribing behaviours of prescribers who provide care to the ambulatory HD population.
Condition or disease
End Stage Renal Failure on DialysisInfection, Bacterial
Prevalence of antimicrobial prescriptions in an ambulatory hemodialysis population [ Time Frame: September 1 2016 - April 30 2017 ]
Prevalence will be determined by the total number of antimicrobial prescriptions in the study population over the period of study. An antimicrobial prescription will be defined as any oral or intravenous antibacterial or antifungal or antiviral agent prescribed by a community or hospital prescriber to a patient receiving hemodialysis (HD) from Toronto General Hospital's outpatient HD unit. An antimicrobial prescription will follow the 21-day rule.The 21-day rule is that there must be 21 or more days from the end of one antimicrobial course to the beginning of a second antimicrobial course for two courses to be reported as separate prescriptions. If antimicrobials are stopped for fewer than 21 days and then restarted, the second start is not considered a new prescription, and therefore will not be reported.
Secondary Outcome Measures :
Congruence of prescribed antimicrobial regimens [ Time Frame: September 1 2016 - April 30 2017 ]
Proportion of antimicrobial prescriptions congruent with available clinical guidelines and antimicrobial stewardship principles based on:
i) indication ii) antimicrobialagent iii) spectrum of activity against most likely causative pathogen iv) dose v) route of administration vi) dosing frequency vii) length of treatment
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Layout table for eligibility information
Ages Eligible for Study:
18 Years and older (Adult, Older Adult)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
The population to be studied in this retrospective chart review includes patients with end-stage renal disease receiving outpatient hemodialysis (HD) treatment at Toronto General Hospital (TGH) who were prescribed at least one antimicrobial during the study period.
≥ 18 years of age
Receiving outpatient hemodialysis (HD) for at least 3 months
Prescribed at least one oral or intravenous antimicrobial (antibacterial or antifungal or antiviral) by a hospital or community prescriber between September 2016 to April 30 2017 inclusive