Selective Reporting for Antibiotic Susceptibility Testing and GPs' Prescribing of Broad-spectrum Antibiotics in Women With E. Coli UTIs (ABC-MG)

Nantes University Hospital (NUH)

Status: Enrolling

Conditions: Urinary Tract Infections

Treatments: Other: Dissemination of a selective reporting for antibiotic susceptibility testing; Other: Standard antibiotic susceptibility testing report

Study type: Interventional

Funder types: Other

Identifiers

NCT06067386

RC22_0003

Details and patient eligibility

About

The control of antibiotic resistance requires a reduction in inappropriate prescriptions of broad-spectrum antibiotics (amoxillin-clavulanate (AMC), fluoroquinolones (FQ), third-generation cephalosporins (C3G)), particularly for urinary tract infections treated in primary care. Several studies have reported the positive impact of antibiotic susceptibility testing performed on urine cultures on the appropriate use of antibiotics.

The "selective reporting for antibiotic susceptibility testing ", defined as the restriction of the list of antibiotics mentioned in the report according to the antibiotic resistance profile, would allow, according to observational studies, a reduction of 25 to 70% of the initial prescriptions of broad-spectrum antibiotics and a 20% rate of antibiotic de-escalation (=reduction of the antibacterial spectrum of an antibiotic treatment after re-evaluation).

The objective is to assess the impact of disseminating a selective reporting for antibiotic susceptibility testing on the dispensing of broad-spectrum antibiotics prescribed by general practitioners (GPs) for E. coli positive urine cultures in adult women, compared to the dissemination of a standard antibiotic susceptibility testing.

Enrollment: 3,000 estimated patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Patients :

• women ≥18 years of age,
• affiliated with the CPAM of Loire Atlantique (44) or Maine et Loire (49),
• with a urine culture: i) analyzed by LabOuest, ii) positive for E. coli, and iii) associated with a prescription for antibiotics by a general practitioner in the period 7 days before and 14 days after the antibiotic susceptibility testing.

General practitioners :

• practicing in primary care Loire Atlantique (44) and/or Maine et Loire (49),
• having been consulted by at least 100 different patients in the 12 months prior to baseline,
• having received at least one urine culture result for a woman ≥18 years of age analyzed by LabOuest over the 12 months prior to baseline.

Exclusion criteria

Patients :

• hospitalized in the period 7 days before and 14 days after antibiotic susceptibility testing (data on antibiotics dispensed in healthcare institutions are not accessible via DCIR data),
• with reimbursements for antibiotics prescribed by physicians in different practices over the period 7 days before and 14 days after antibiotic susceptibility testing.

General practitioners :

• with a special practice (acupuncture, allergology, angiology).
• not receiving any urine culture results analyzed by a laboratory of the LabOuest network in the year following the intervention

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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3,000 participants in 2 patient groups

Intervention arm

Experimental group

Description:

For each E. coli positive urine culture analyzed by LabOuest, GPs will receive an antibiotic susceptibility testing report, with the list of antibiotics restricted according to four E. coli susceptibility profiles, with an emphasis on narrower-spectrum antibiotics. The selected antibiotic susceptibility testing was developed following a targeted literature review and consultation with a steering committee including GPs, biologists and infectiologists. At the GP's request, a full antibiogram can be provided.

Treatment:

Other: Dissemination of a selective reporting for antibiotic susceptibility testing

Control arm

Active Comparator group

Description:

GPs will receive a standard antibiotic susceptibility testing report for each E. coli positive urine culture.

Treatment:

Other: Standard antibiotic susceptibility testing report