Yoon 2014.
| Methods | STUDY DESIGN: ITS Risk of Bias: MEDIUM |
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| Participants | PROVIDERS: all physicians in the hospital PARTICIPANTS: all patients in the hospital CLINICAL PROBLEM: requiring therapeutic antibiotics and receiving carbapenems SETTING: 1 university hospital in Korea, same hospital as Kim 2008 | |
| Interventions | FORMAT: Intervention 1: restrictive by expert approval (same intervention format as Kim 2008) Intervention 1 functions: restriction Intervention 2: addition of reminders (circumstantial, electronic triggered by computerised antibiotic order, the system is described in more detail in Kim 2008) Intervention 2 functions: enablement, environmental restructuring, persuasion DELIVERER: AMT COMPARISON: usual care DESIRED CHANGE: decrease excessive |
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| Outcomes | PRESCRIBING: Choice: use of carbapenems in DDD/1000 OBD MICROBIAL: infections with CRAB (carbapenem‐resistant Acinetobacter baumanii)/1000 OBD CLINICAL: Balancing measures of adverse effects, all‐cause mortality |
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| Notes | FINANCIAL SUPPORT: Funding: commercial, Merck Sharp & Dohme. Competing Interests: supported by Merck Sharp & Dohme Corp. ADDITIONAL DATA: no response from authors to request for additional data Microbial Risk of Bias: HIGH case definition Low, planned intervention Low, other infection control High, ICU cleaning intervention during Phase 3 |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Intervention independent (ITS) ? | High risk | Intensive environmental cleaning implemented in 2012 in ICU, which was intended to reduce infections with CRAB (microbial outcome). |
| Analysed appropriately (ITS) ? | Low risk | Segmented regression analysis |
| Shape of effect pre‐specified (ITS) ? | Low risk | Point of intervention was point of analysis. |
| Unlikely to affect data collection (ITS) ? | Low risk | Data from pharmacy and microbiology computers |
| Knowledge of the allocation adequately prevented(ITS)? | Low risk | Data from pharmacy and microbiology computers |
| Incomplete outcome data addressed (ITS) ? | Low risk | Data from pharmacy and microbiology computers |
| Free of selected reporting (ITS) ? | Low risk | Data from pharmacy and microbiology computers |
| Free of other bias (ITS) ? | Low risk | > 1 year data in each study phase |