Telemedicine-based Antibiotic Stewardship Program in Pediatrics: Study Protocol of a Stepped Wedge Cluster Randomized Trial-the TeleKasper Study

Overview

Journal Trials

Publisher Biomed Central

Specialties General Medicine
Pharmacology

Date 2024 Oct 14

PMID 39402608

Authors

Sophie Diexer

Angelika Ihling

Delphina Gomes

Stefan Moritz

Arne Simon

Christian Dohna-Schwake

Rafael Mikolajczyk

Johannes Huebner

Ulrich von Both

Affiliations

Soon will be listed here.

Abstract

Background: Overuse and misuse of antibiotics is one of the driving factors of antimicrobial resistance, a growing global health threat. The use of antibiotics is particularly high in children. Even though the implementation of antibiotic stewardship programs (ASP) in pediatrics has been shown to reduce antibiotic use, this implementation has been limited to large university hospitals in Germany. Telemedicine applications might be an effective approach to implement ASP in non-university settings.

Methods: This protocol details the TeleKasper study (Telemedical Competence Network "Antibiotic Stewardship in Pediatrics"). Tele-Kasper is a stepped-wedge cluster-randomized trial that will be conducted across non-university children's hospitals in Germany. The intervention consists of a telemedical consultation service in the form of a network in different German areas, using an app as a communication tool. The primary outcome will be a 20% reduction in overall antibiotic consumption measured using defined daily doses per 100 patient days.

Discussion: The TeleKasper study aims to implement and evaluate a prototype for a nationwide antibiotic stewardship program by telemedical means in pediatric departments in non-university hospitals in Germany to promote rational antibiotic use and improve medical care for infections.

Trial Registration: German Clinical Trials Register (DRKS) DRKS00028534. Registered on 22nd of April 2022.

References

Morquin D, Ologeanu-Taddei R, Koumar Y, Bourret R, Reynes J . Implementing a tele-expertise system to optimise the antibiotic use and stewardship: The case of the Montpellier University Hospital (France). Stud Health Technol Inform. 2015; 210:296-300. View

Maison N, Omony J, Rinderknecht S, Kolberg L, Meyer-Buhn M, von Mutius E . Old foes following news ways?-Pandemic-related changes in the epidemiology of viral respiratory tract infections. Infection. 2023; 52(1):209-218. PMC: 10811157. DOI: 10.1007/s15010-023-02085-w. View

Holstiege J, Garbe E . Systemic antibiotic use among children and adolescents in Germany: a population-based study. Eur J Pediatr. 2013; 172(6):787-95. DOI: 10.1007/s00431-013-1958-y. View

Chan A, Tetzlaff J, Gotzsche P, Altman D, Mann H, Berlin J . SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013; 346:e7586. PMC: 3541470. DOI: 10.1136/bmj.e7586. View

Kronman M, Banerjee R, Duchon J, Gerber J, Green M, Hersh A . Expanding Existing Antimicrobial Stewardship Programs in Pediatrics: What Comes Next. J Pediatric Infect Dis Soc. 2017; 7(3):241-248. PMC: 7107461. DOI: 10.1093/jpids/pix104. View

Probst V, Islamovic F, Mirza A . Antimicrobial stewardship program in pediatric medicine. Pediatr Investig. 2021; 5(3):229-238. PMC: 8458720. DOI: 10.1002/ped4.12292. View

Goossens H . Antibiotic consumption and link to resistance. Clin Microbiol Infect. 2009; 15 Suppl 3:12-5. DOI: 10.1111/j.1469-0691.2009.02725.x. View

Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H . The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016; 71(4):1106-17. DOI: 10.1093/jac/dkv418. View

Weiss K, Simon A . Antibiotic Stewardship and Hospital Hygiene in German Paediatric Inpatient Facilities: A Qualitative Survey from the Paed IC Working Group. Klin Padiatr. 2016; 228(5):257-62. DOI: 10.1055/s-0042-109710. View

10.

Dellit T, Owens R, McGowan Jr J, Gerding D, Weinstein R, Burke J . Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2006; 44(2):159-77. DOI: 10.1086/510393. View

11.

Dirjayanto V, Lazarus G, Geraldine P, Dyson N, Triastari S, Anjani J . Efficacy of telemedicine-based antimicrobial stewardship program to combat antimicrobial resistance: A systematic review and meta-analysis. J Telemed Telecare. 2023; :1357633X231204919. DOI: 10.1177/1357633X231204919. View

12.

Turner R, Valcarlos E, Loeffler A, Gilbert M, Chan D . Impact of an Antimicrobial Stewardship Program on Antibiotic Use at a Nonfreestanding Children's Hospital. J Pediatric Infect Dis Soc. 2017; 6(3):e36-e40. DOI: 10.1093/jpids/piw059. View

13.

Alfraij A, Abdelmoniem A, ElSeadawy M, Surour M, Basuni M, Papenburg J . The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study. J Infect Public Health. 2023; 16(9):1361-1367. DOI: 10.1016/j.jiph.2023.06.010. View

14.

Godbout E, Pakyz A, Markley J, Noda A, Stevens M . Pediatric Antimicrobial Stewardship: State of the Art. Curr Infect Dis Rep. 2018; 20(10):39. DOI: 10.1007/s11908-018-0644-7. View

15.

Maison N, Peck A, Illi S, Meyer-Buehn M, von Mutius E, Hubner J . The rising of old foes: impact of lockdown periods on "non-SARS-CoV-2" viral respiratory and gastrointestinal infections. Infection. 2022; 50(2):519-524. PMC: 8787179. DOI: 10.1007/s15010-022-01756-4. View