An Online Platform for Expanding Antibiotic Stewardship



Research Project: 2018-01-01 - 2021-12-31
Total sum awarded: €993 400

Antibiotic resistance is a mounting public health threat calling for action on global, national and local levels. Antibiotic use has been a major driver of increasing rates of antibiotic resistance. This has given rise to the practice of antibiotic stewardship, which seeks to reduce unnecessary antibiotic use across different care settings. Antibiotic stewardship has been increasingly applied in hospital settings, but adoption has been slow in many ambulatory care settings including primary care of humans. Uptake of antibiotic stewardship in veterinary care has been similarly limited. Audit and feedback systems of antibiotic use coupled with patterns of antibiotic use and best practice guidelines have proven useful in outpatient settings, but scale-up is limited by heterogeneous systems of care and limited resources. We aim to develop an open web-based system that allows for advanced stewardship interventions in the form of feedback and benchmarking as well as sharing of best practice guidelines and antibiotic resistance patterns. The proposed model can be rapidly expanded across health systems, countries, and sectors (animal vs. human), with minimal resource expenditures. We will build upon an existing platform for monitoring antibiotic resistance, and pilot these interventions with international providers in both medicine and veterinary medicine, in the form of an interrupted time series analysis. Outcomes will focus on platform development, interface usability, and prescription patterns during the study

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  • David Fisman, University of Toronto, Canada (Coordinator)
  • Sonja Löfmark, Public Health Agency of Sweden, Sweden (Partner)
  • Amy Greer, University of Guelph, Canada (Partner)
  • Nadav Davidovitch, Ben-Gurion University, Israel (Partner)
  • Moriah Ellen, Jerusalem College of Technology, Israel (Partner)
  • John Brownstein, Harvard Medical School, USA (Observer)
  • Derek MacFadden, Boston Children's Hospital, USA (Observer)

Antibiotic resistance is a major global public health threat. Infections due to antibiotic resistant organisms are hard to treat with conventional antibiotics and is linked to worse outcomes for patients. Antibiotic use is a major driver of antibiotic resistance. Because antibiotic resistant organisms and genes can be shared between humans, animals, and the environment, we need to reduce antibiotic use in all settings. One approach to reduce antibiotic use is helping prescribers use less antibiotics. This is reasonable because a large number of antibiotics are unnecessary. By supporting providers with guidelines and peer benchmarking, we can help them give less antibiotics and for shorter durations. Unfortunately providing effective antibiotic stewardship can be challenging in primary care and veterinary settings, where it is needed most. In part because of resources and lack of adequate tools. We developed an open-collaboration tool that allows antibiotic stewardship champions to provide antibiotic stewardship feedback reports to providers to help them prescribe less. And this tool works both for human providers and veterinarians. We evaluated our tool across two countries, Canada and Israel, and with both physicians and veterinarians. We found a positive impact on prescribing with multiple feedback interventions for veterinarians, and a signal for reduced antibiotic prescribing duration in physicians. Moreover, the feedback reports were felt to be useful and frequently felt to impact care. We hope this tool will be broadly useful for deployment in numerous health settings to support antibiotic stewardship interventions globally, reducing antibiotic use and working to stem the tide of antibiotic resistance.