Evidence map›Paper›PMID 36813284›Full record

Trial reportBMJ (Clinical research ed.)2023

Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries.

Esther A R Hartman, Alma C van de Pol, Silje Rebekka Heltveit-Olsen, Morten Lindbæk, Sigurd Høye, Sara Sofia Lithén, Pär-Daniel Sundvall, Sofia Sundvall, Egill Snaebjörnsson Arnljots, Ronny Gunnarsson and 8 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03970356 (The Improving Rational Prescribing for Urinary Tract Infections in Frail Elderly), which is not on this map. Cited by 32 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
32citing papers in PubMed, 3 pooled it
10.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03970356 nacompletednot on this map

The Improving Rational Prescribing for Urinary Tract Infections in Frail Elderly (ImpresU) Project - Work Package 2 (WP2): a Cluster Randomised Multifaceted Antibiotic Stewardship Intervention Study

TypeinterventionalSponsorCees HertoghRan2019 to 2021Enrolled1,146ConditionsUrinary Tract InfectionsArmsantibiotic stewardship intervention
3 · Its place in the literature

Who cites it

32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 49 citations in OpenAlex.

  1. Pooled it
  2. Tailored interventions to address determinants of practice.The Cochrane database of systematic reviews · 2026
    Pooled it
  3. Pooled it
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  7. Trial
  8. Review
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  10. Article
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  15. Observational
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  18. Review
  19. Prescribing for change - safer antimicrobial use in hospitals.Clinical medicine (London, England) · 2024
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors at 5 institutions in 4 countries.

Esther A R HartmanDepartment of Medicine for Older People, Amsterdam UMC, Vrije University of Amsterdam, Amsterdam, Netherlands e.hartman1@amsterdamumc.nl.ORCID 0000-0003-0907-2476
Alma C van de PolJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Silje Rebekka Heltveit-OlsenAntibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.ORCID 0000-0002-8645-5836
Morten LindbækAntibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Sigurd HøyeAntibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Sara Sofia LithénAntibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Pär-Daniel SundvallGeneral Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Sofia SundvallResearch, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, Borås, Sweden.
Egill Snaebjörnsson ArnljotsGeneral Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Ronny GunnarssonGeneral Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Anna KowalczykCentre for Family and Community Medicine, the Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.
Maciek Godycki-CwirkoCentre for Family and Community Medicine, the Faculty of Health Sciences, Medical University of Lodz, Lodz, Poland.
Tamara N PlatteelJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Wim G GroenDepartment of Medicine for Older People, Amsterdam UMC, Vrije University of Amsterdam, Amsterdam, Netherlands.
Annelie A MonnierDepartment of Medicine for Older People, Amsterdam UMC, Vrije University of Amsterdam, Amsterdam, Netherlands.ORCID 0000-0002-5844-286X
Nicolaas P ZuithoffJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Theo J M VerheijJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Cees M P M HertoghDepartment of Medicine for Older People, Amsterdam UMC, Vrije University of Amsterdam, Amsterdam, Netherlands.
Utrecht University · NLRegion Västra Götaland · SEUniversity of Oslo · NOAmsterdam University Medical Centers · NLMedical University of Lodz · PL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention.

designPragmatic, parallel, cluster randomised controlled trial, with a five month baseline period and a seven month follow-up period.

setting38 clusters consisting of one or more general practices (n=43) and older adult care organisations (n=43) in Poland, the Netherlands, Norway, and Sweden, from September 2019 to June 2021.

participants1041 frail older adults aged 70 or older (Poland 325, the Netherlands 233, Norway 276, Sweden 207), contributing 411 person years to the follow-up period.

interventionHealthcare professionals received a multifaceted antibiotic stewardship intervention consisting of a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. A participatory-action-research approach was used for implementation, with sessions for education, evaluation, and local tailoring of the intervention. The control group provided care as usual.

main outcome measuresThe primary outcome was the number of antibiotic prescriptions for suspected urinary tract infections per person year. Secondary outcomes included the incidence of complications, all cause hospital referrals, all cause hospital admissions, all cause mortality within 21 days after suspected urinary tract infections, and all cause mortality.

resultsThe 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

conclusionsImplementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults.

trial registrationClinicalTrials.gov NCT03970356.

Indexed as

Antimicrobial StewardshipRespiratory Tract InfectionsUrinary Tract InfectionsAgedAnti-Bacterial AgentsFrail ElderlyHumansAnti-Bacterial Agents

Identifiers

PMID36813284
PMCPMC9943914
OpenAlexW4321523751

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.