Hospital Wide Roll-out of Antimicrobial Stewardship: A Stepped Wedge Randomized Controlled Trial

The objective of this study was to determine the impact of an antimicrobial stewardship intervention in six non-intensive care services. A review of all patients on their 3rd and 10th day of broad-spectrum antibiotic therapy was conducted at Sunnybrook Health Sciences Centre using a stepped–wedge randomized design. The primary outcome was broad-spectrum antimicrobial utilization in the intervention period compared to the control period. Despite high volumes and uptake of stewardship recommendations, a non-significant reduction in targeted antimicrobial utilization was achieved; however, median length of stay of the patients included was ~4 days, limiting the ability of the intervention to make a significant impact on inpatient antimicrobial utilization. Careful consideration of the targeted patient population is, therefore, warranted when planning and implementing antimicrobial stewardship interventions. Future work may focus on intervening earlier in the course of therapy.MAS