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NCT Number: NCT07115966

Impact of a Simple Automated Best Practice Alert (BPA) on Quantity and Quality of In-hospital Antibiotic Use in a Tertiary and Three Secondary Hospitals

The goal of the stepped-wedge cluster-randomized trial is to assess the impact of an antimicrobial stewardship intervention: a simple, automated Best Practice Alert (BPA) that reminds prescribers to reevaluate antibiotic therapy after 72 hours (or 24 hours for prophylaxis), in accordance with guideline recommendations. The primary hypothesis is that this simple BPA reduces antibiotic use in terms of quantity (amount and duration) and quality (spectrum breadth), measured by days of antibiotic spectrum coverage at the patient level (primary outcome), as well as at both patient and cluster levels using various metrics of antibiotic use. The trial will introduce the BPA in a stepwise manner, with all wards implementing it by the end. It will compare the intervention period to the baseline (pre-intervention) and control periods.

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This study is active but is not currently recruiting participants.

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Key information

Conditions

Antibiotic Prescriptions In-Patient Treatment

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Inselgruppe

Bern, 3007, Switzerland

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • All inpatient wards with at least 50 PA/year, except those listed in the exclusion criteria

Exclusion criteria

Ward level:

  • Emergency departments
  • Outpatient clinics
  • Haemato-oncologic stem cell transplant wards, where daily ID visits are performed
  • ICU wards, where daily ID visits are performed

Indvidual patient data for analysis

  • Refusal of institutional general consent for further use of patient data

Treatment and study plan

Computerized decision support by best practice alert (BPA)

Behavioral

The antimicrobial stewardship intervention encourages prescribers by a simple alert to follow guidelines for reviewing antimicrobial prescriptions after a set timeframe for potential de-escalation to targeted therapy or discontinuation of the antibiotics, as recommended by national and international guidelines.

An automated simple BPA will trigger after an antibiotic prescription with therapeutic indication (72 hours) or surgical prophylaxis (24 hours, reminding prescribers to reassess treatment for possible de-escalation, adaption to targeted therapy, or cessation.

If ignored, the prescription remains unchanged, but the alert will continue until addressed. Prescribers must select reasons for not changing the prescription, such as pending microbiology results. The control group corresponds to the inpatient wards not yet receiving the BPA, where antibiotics are managed according to "standard-of-care".

Primary outcomes

  1. Days of antibiotic spectrum coverage (DASC) per patient admission (PA)

    Time frame: 12 months

    Overall score of days of antibiotic spectrum coverage per patient admission. The score is composed of the breadth of the bacterial spectrum covered by the administered antibiotic (according to Kakiuchi 2022 - the broader the antibiotic spectrum, the higher the score), summed over the number of days the antibiotic is given. Accordingly, there are no maximum or minimum values

Secondary outcomes

  1. Days of antibiotic spectrum coverage (DASC) per patient antibiotic day (PAD)

    Time frame: 12 months

    Overall score of antibiotic spectrum coverage per patient antibiotic day. The score is composed of the breadth of the bacterial spectrum covered by the administered antibiotic (according to Kakiuchi 2022 - the broader the antibiotic spectrum, the higher the score), summed over the number of days the antibiotic is given. Accordingly, there are no maximum or minimum values.

  2. Days of treatment (DOT) per 100 patient days (PD) and per patient admission on ward level

    Time frame: 12 months

    Overall days of treatment (DOT) per 100 patient days (PD) and per patient admission (PA) on ward level

  3. Defined daily doses (DDD) per 100 patient days (PD) and per patient admission (PA)

    Time frame: 12 months

    Overall defined daily doses) per 100 patient days (PD) and per patient admission (PA) on ward level. Standard metrics recommended by WHO for international benchmarking.

  4. Antibiotic (AB) days per patient admission (PA)

    Time frame: 12 months

    No of days an AB per PA gives the proportion of days antibiotics have been applicated, irrespective of single, double, triple combinations, in relation to total PA

  5. In hospital mortality

    Time frame: 12 months

    All cause in hospital mortality

  6. Hospital length of stay (LOS)

    Time frame: 12 months

  7. Unplanned readmission within first 30 days after discharge

    Time frame: 12 months

  8. Patient admission to IMC/ICU from studied wards

    Time frame: 12 months

    Number and proportion of patient admissions to IMC/ICU from studied wards

  9. Number of Infectious diseases (ID) consultation per patient admission (PA)

    Time frame: 12 months

  10. In hospital C. difficile infection incidence within hospital stay per patient admission (PA) and per 100 patient days (PD)

    Time frame: 12 months

  11. Inhospital incidence of multi-drug-resistant-organisms (MDRO) detection per100 patient days (PD) or per patient admission (PA)

    Time frame: 12 months

Sponsors and collaborators

Lead sponsor

Insel Gruppe AG, University Hospital Bern

Other

Registry information

Official study title

Impact of a Simple Automated Best Practice Alert (BPA) on Quantity and Quality of In-hospital Antibiotic Use - a Stepped-wedge, Cluster Randomized, Controlled Trial

Acronym: TARGET

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Aug 11, 2025
Registry last updated
Sep 2, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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