Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study

Nonke E.M. Hopman, Lützen Portengen, Marlies E.J.L. Hulscher, Dick J.J. Heederik, T.J.M. Verheij, Jaap A. Wagenaar, Jan M. Prins, Tjerk Bosje, Louska Schipper, Ingeborg M. Van Geijlswijk, Els M. Broens*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background To curb increasing resistance rates, responsible antimicrobial use (AMU) is needed, both in human and veterinary medicine. In human healthcare, antimicrobial stewardship programmes (ASPs) have been implemented worldwide to improve appropriate AMU. No ASPs have been developed for and implemented in companion animal clinics yet. Objectives The objective of the present study was to implement and evaluate the effectiveness of an ASP in 44 Dutch companion animal clinics. The objectives of the ASP were to increase awareness on AMU, to decrease total AMU whenever possible and to shift AMU towards 1st choice antimicrobials, according to Dutch guidelines on veterinary AMU. Methods The study was designed as a prospective, stepped-wedge, intervention study, which was performed from March 2016 until March 2018. The multifaceted intervention was developed using previous qualitative and quantitative research on current prescribing behaviour in Dutch companion animal clinics. The number of Defined Daily Doses for Animal (DDDAs) per clinic (total, 1st, 2nd and 3rd choice AMU) was used to quantify systemic AMU. Monthly AMU data were described using a mixed effect time series model with auto-regression. The effect of the ASP was modelled using a step function and a change in the (linear) time trend. Results A statistically significant decrease of 15% (7%-22%) in total AMU, 15% (5%-24%) in 1st choice AMU and 26% (17%-34%) in 2nd choice AMU was attributed to participation in the ASP, on top of the already ongoing time trends. Use of 3rd choice AMs did not significantly decrease by participation in the ASP. The change in total AMU became more prominent over time, with a 16% (4%-26%) decrease in (linear) time trend per year. Conclusions This study shows that, although AMU in Dutch companion animal clinics was already decreasing and changing, AMU could be further optimised by participation in an antimicrobial stewardship programme.

Original languageEnglish
Article numbere0225124
JournalPLoS ONE
Volume14
Issue number11
DOIs
Publication statusPublished - 18 Nov 2019

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anti-infective agents
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Hopman, N. E. M., Portengen, L., Hulscher, M. E. J. L., Heederik, D. J. J., Verheij, T. J. M., Wagenaar, J. A., ... Broens, E. M. (2019). Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study. PLoS ONE, 14(11), [e0225124]. https://doi.org/10.1371/journal.pone.0225124
Hopman, Nonke E.M. ; Portengen, Lützen ; Hulscher, Marlies E.J.L. ; Heederik, Dick J.J. ; Verheij, T.J.M. ; Wagenaar, Jaap A. ; Prins, Jan M. ; Bosje, Tjerk ; Schipper, Louska ; Van Geijlswijk, Ingeborg M. ; Broens, Els M. / Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study. In: PLoS ONE. 2019 ; Vol. 14, No. 11.
@article{db28b013582041b898c830c0e15c0bd3,
title = "Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study",
abstract = "Background To curb increasing resistance rates, responsible antimicrobial use (AMU) is needed, both in human and veterinary medicine. In human healthcare, antimicrobial stewardship programmes (ASPs) have been implemented worldwide to improve appropriate AMU. No ASPs have been developed for and implemented in companion animal clinics yet. Objectives The objective of the present study was to implement and evaluate the effectiveness of an ASP in 44 Dutch companion animal clinics. The objectives of the ASP were to increase awareness on AMU, to decrease total AMU whenever possible and to shift AMU towards 1st choice antimicrobials, according to Dutch guidelines on veterinary AMU. Methods The study was designed as a prospective, stepped-wedge, intervention study, which was performed from March 2016 until March 2018. The multifaceted intervention was developed using previous qualitative and quantitative research on current prescribing behaviour in Dutch companion animal clinics. The number of Defined Daily Doses for Animal (DDDAs) per clinic (total, 1st, 2nd and 3rd choice AMU) was used to quantify systemic AMU. Monthly AMU data were described using a mixed effect time series model with auto-regression. The effect of the ASP was modelled using a step function and a change in the (linear) time trend. Results A statistically significant decrease of 15{\%} (7{\%}-22{\%}) in total AMU, 15{\%} (5{\%}-24{\%}) in 1st choice AMU and 26{\%} (17{\%}-34{\%}) in 2nd choice AMU was attributed to participation in the ASP, on top of the already ongoing time trends. Use of 3rd choice AMs did not significantly decrease by participation in the ASP. The change in total AMU became more prominent over time, with a 16{\%} (4{\%}-26{\%}) decrease in (linear) time trend per year. Conclusions This study shows that, although AMU in Dutch companion animal clinics was already decreasing and changing, AMU could be further optimised by participation in an antimicrobial stewardship programme.",
author = "Hopman, {Nonke E.M.} and L{\"u}tzen Portengen and Hulscher, {Marlies E.J.L.} and Heederik, {Dick J.J.} and T.J.M. Verheij and Wagenaar, {Jaap A.} and Prins, {Jan M.} and Tjerk Bosje and Louska Schipper and {Van Geijlswijk}, {Ingeborg M.} and Broens, {Els M.}",
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Hopman, NEM, Portengen, L, Hulscher, MEJL, Heederik, DJJ, Verheij, TJM, Wagenaar, JA, Prins, JM, Bosje, T, Schipper, L, Van Geijlswijk, IM & Broens, EM 2019, 'Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study', PLoS ONE, vol. 14, no. 11, e0225124. https://doi.org/10.1371/journal.pone.0225124

Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study. / Hopman, Nonke E.M.; Portengen, Lützen; Hulscher, Marlies E.J.L.; Heederik, Dick J.J.; Verheij, T.J.M.; Wagenaar, Jaap A.; Prins, Jan M.; Bosje, Tjerk; Schipper, Louska; Van Geijlswijk, Ingeborg M.; Broens, Els M.

In: PLoS ONE, Vol. 14, No. 11, e0225124, 18.11.2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study

AU - Hopman, Nonke E.M.

AU - Portengen, Lützen

AU - Hulscher, Marlies E.J.L.

AU - Heederik, Dick J.J.

AU - Verheij, T.J.M.

AU - Wagenaar, Jaap A.

AU - Prins, Jan M.

AU - Bosje, Tjerk

AU - Schipper, Louska

AU - Van Geijlswijk, Ingeborg M.

AU - Broens, Els M.

PY - 2019/11/18

Y1 - 2019/11/18

N2 - Background To curb increasing resistance rates, responsible antimicrobial use (AMU) is needed, both in human and veterinary medicine. In human healthcare, antimicrobial stewardship programmes (ASPs) have been implemented worldwide to improve appropriate AMU. No ASPs have been developed for and implemented in companion animal clinics yet. Objectives The objective of the present study was to implement and evaluate the effectiveness of an ASP in 44 Dutch companion animal clinics. The objectives of the ASP were to increase awareness on AMU, to decrease total AMU whenever possible and to shift AMU towards 1st choice antimicrobials, according to Dutch guidelines on veterinary AMU. Methods The study was designed as a prospective, stepped-wedge, intervention study, which was performed from March 2016 until March 2018. The multifaceted intervention was developed using previous qualitative and quantitative research on current prescribing behaviour in Dutch companion animal clinics. The number of Defined Daily Doses for Animal (DDDAs) per clinic (total, 1st, 2nd and 3rd choice AMU) was used to quantify systemic AMU. Monthly AMU data were described using a mixed effect time series model with auto-regression. The effect of the ASP was modelled using a step function and a change in the (linear) time trend. Results A statistically significant decrease of 15% (7%-22%) in total AMU, 15% (5%-24%) in 1st choice AMU and 26% (17%-34%) in 2nd choice AMU was attributed to participation in the ASP, on top of the already ongoing time trends. Use of 3rd choice AMs did not significantly decrease by participation in the ASP. The change in total AMU became more prominent over time, with a 16% (4%-26%) decrease in (linear) time trend per year. Conclusions This study shows that, although AMU in Dutch companion animal clinics was already decreasing and changing, AMU could be further optimised by participation in an antimicrobial stewardship programme.

AB - Background To curb increasing resistance rates, responsible antimicrobial use (AMU) is needed, both in human and veterinary medicine. In human healthcare, antimicrobial stewardship programmes (ASPs) have been implemented worldwide to improve appropriate AMU. No ASPs have been developed for and implemented in companion animal clinics yet. Objectives The objective of the present study was to implement and evaluate the effectiveness of an ASP in 44 Dutch companion animal clinics. The objectives of the ASP were to increase awareness on AMU, to decrease total AMU whenever possible and to shift AMU towards 1st choice antimicrobials, according to Dutch guidelines on veterinary AMU. Methods The study was designed as a prospective, stepped-wedge, intervention study, which was performed from March 2016 until March 2018. The multifaceted intervention was developed using previous qualitative and quantitative research on current prescribing behaviour in Dutch companion animal clinics. The number of Defined Daily Doses for Animal (DDDAs) per clinic (total, 1st, 2nd and 3rd choice AMU) was used to quantify systemic AMU. Monthly AMU data were described using a mixed effect time series model with auto-regression. The effect of the ASP was modelled using a step function and a change in the (linear) time trend. Results A statistically significant decrease of 15% (7%-22%) in total AMU, 15% (5%-24%) in 1st choice AMU and 26% (17%-34%) in 2nd choice AMU was attributed to participation in the ASP, on top of the already ongoing time trends. Use of 3rd choice AMs did not significantly decrease by participation in the ASP. The change in total AMU became more prominent over time, with a 16% (4%-26%) decrease in (linear) time trend per year. Conclusions This study shows that, although AMU in Dutch companion animal clinics was already decreasing and changing, AMU could be further optimised by participation in an antimicrobial stewardship programme.

U2 - 10.1371/journal.pone.0225124

DO - 10.1371/journal.pone.0225124

M3 - Article

VL - 14

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 11

M1 - e0225124

ER -