Life In The Slower Lane

Here is the structured PICO analysis for the fifth article you uploaded:

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Full Title (verbatim and exact):

“Implementation of an antimicrobial stewardship program for urinary tract infections in long-term care facilities: a cluster-controlled intervention study”

Elisabeth König, Lisa Kriegl, et al.

Antimicrobial Resistance & Infection Control (2024) 13:43

DOI: https://doi.org/10.1186/s13756-024-01397-2

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Type of Article:

Non-randomised cluster-controlled intervention study

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PICO Analysis:

Population:

• Residents of 8 long-term care facilities (LTCFs) in Austria
  • 4 LTCFs (400 beds) in Graz formed the intervention group
  • 4 LTCFs from a nearby region served as control
• Participants included 194 residents with 326 UTI episodes recorded during the study period
• Median age: 87 years; 72% were female 

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Intervention:

A multi-faceted antimicrobial stewardship program for urinary tract infections (UTIs), targeting both nursing staff and general practitioners, including:

• Written guidelines for diagnosis and antibiotic selection
• In-person and online education and training on:
  • Symptom recognition
  • Appropriate use of urinary cultures
  • Avoiding quinolone use without catheter
  • Dosing and selection of antimicrobials
• Distribution of handouts and educational videos
• Use of a project website for resource dissemination 

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Comparator:

• Usual care in the control group (no structured antimicrobial stewardship intervention)
• The control LTCFs were located in a different region to avoid cross-contamination of practices

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Outcome:

1. Person-centred outcomes:

• Not the primary focus, but monitored adverse effects, hospital admissions, and clinical failure as safety proxies

2. Process outcomes:

• Primary outcome: Adequate antimicrobial prescription (choice and dosage)
  • Intervention group improvement: 42.1% → 51% across study phases
  • Control group: Remained ~33% across time
• Secondary outcomes:
  • Adequate decision to treat significantly improved during intervention (RR = 0.41, p = 0.025)
  • Reduced inappropriate quinolone use in patients without catheters
  • More urinary cultures obtained in the intervention group
  • High inter-reviewer agreement on assessment quality (κ = 0.98) 

3. Health system outcomes:

• No significant differences in adverse events, clinical failures, or hospitalisations
• Intervention group showed potential for improving prescribing quality without compromising safety 

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