Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial

Improving Antibiotic Prescribing for Older Adults: Key Findings from the ImpresU Study

Background

We conducted a study in Poland, the Netherlands, Norway, and Sweden to address antibiotic use for urinary tract infections (UTIs) in frail older adults. Our intervention significantly decreased antibiotic prescriptions compared to standard care.

Methods

We evaluated our intervention, which included a decision tool and a toolbox, using a hands-on research approach. This involved educational sessions for healthcare professionals (HCPs) to ensure effective implementation.

Results

A total of 254 HCPs from 38 clusters participated. The intervention components were delivered successfully and deemed valuable. Key findings include:

  • The decision tool and materials helped HCPs make better decisions regarding UTIs.
  • Educational sessions clarified the difference between UTIs and asymptomatic bacteriuria.
  • Reflection sessions helped HCPs identify and overcome challenges in implementation.
  • Some HCPs organized additional training and updated local policies to support the intervention.

Contextual barriers included staff changes and the COVID-19 pandemic.

Conclusions

The components of our intervention proved valuable in enhancing antibiotic prescribing practices. We recommend a collaborative approach that encourages HCPs to reflect on their practices and adapt their methods locally.

Trial Registration

ClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

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