Zanetti 2003.
| Methods | STUDY DESIGN: NRT Risk of Bias: HIGH |
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| Participants | PROVIDERS: all surgeons in the hospital PARTICIPANTS: 331 patients undergoing cardiac surgery CLINICAL PROBLEM: additional dose of antibiotic prophylaxis for operations that lasted more than 4 hours SETTING: 1 hospital in the USA | |
| Interventions | FORMAT: Intervention: dissemination of guideline; reminder (circumstantial, electronic, automated intra‐operative alert) Intervention Functions: education, enablement, environmental restructuring, persuasion COMPARISON: control group plus 480 patients from the 6 months before the study period DESIRED CHANGE: increase effective |
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| Outcomes | PRESCRIBING: Exposure: % patients who received additional intra‐operative antibiotics CLINICAL: Intended: wound infection rate |
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| Notes | FINANCIAL SUPPORT: Funding: Centers for Disease Control and Prevention cooperative agreement, UR8/CCU115079, University Hospital of Lausanne, and the Leenaards Foundation. Competing Interests: no information ADDITIONAL DATA: no response from authors to request for additional data |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Based on a case number assigned to every surgical procedure performed in the hospital, independent of the study itself |
| Allocation concealment (selection bias) | High risk | No concealment |
| Blinding (performance bias and detection bias) All outcomes | High risk | No blinding |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Outcome on all 273 patients |
| Selective reporting (reporting bias) | Low risk | Outcome on all 273 patients |
| Other bias | Low risk | Outcome on all 273 patients |
| Baseline Outcomes similar? | Low risk | Cohort data before start of trial |
| Free of contamination? | High risk | Control patients were operated on by the same surgeons, and the reminder for intervention patients is likely to have increased awareness of the need for additional doses. |
| Baseline characteristics similar? | Low risk | Table 1 |
AB: antibiotic AKI: acute kidney injury AMT: multidisciplinary antibiotic management team APACHE: Acute Physiology and Chronic Health Evaluation ARGNB: antibiotic‐resistant gram‐negative bacilli ARGPB: antibiotic‐resistant gram‐positive bacilli ARIMA: autoregressive integrated moving average ASP: Antimicrobial Stewardship Program BCT: behaviour change technique CAP: community‐acquired pneumonia CBA: controlled before‐after study CBC: complete blood count CDAD: Clostridium difficile‐associated diarrhoea CDC: Centers for Disease Control and Prevention CDI: Clostridium difficile infection CDSS: clinical decision support system CI: confidence interval CITS: comparative interrupted time series CPIS: clinical pulmonary infection score CRP: C‐reactive protein C‐section: Caesarean section DACT: double anaerobic coverage therapy DDD: defined daily dose DRG: diagnosis‐related group ED: emergency department EPOC: Effective Practice and Organisation of Care ER: emergency room ESBL‐EB: extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae FTE: full‐time equivalent GRE: glycopeptide‐resistant enterococci IC: infectious control ICD: International Classification of Diseases ICU: intensive care unit ID: infectious diseases IDP: infectious diseases physician IHC: Intermountain Healthcare IL‐8: interleukin‐8 ITS: interrupted time series IQR: interquartile range IV: intravenous LOS: length of stay MRSA: methicillin‐resistant Staphylococcus aureus MSSA: methicillin‐sensitive Staphylococcus aureus LRTI: lower respiratory tract infection MICU: medical intensive care unit NHAP: nursing home‐acquired pneumonia NIH: National Institutes of Health NRT: non‐randomised (controlled) trial NRSI: non‐randomised studies of interventions OBD: occupied bed day OR: odds ratio PA: parenteral antibiotics PCR: polymerase chain reaction PCT: procalcitonin RCT: randomised controlled trial RCOG: Royal College of Obstetricians and Gynaecologists RDD: recommended daily doses ROB: risk of bias ROBINS‐I: risk of bias in non‐randomised studies of interventions RR: risk ratio SCIP: Surgical Care Improvement Project SD: standard deviation SE: standard error SHEA: Society for Healthcare Epidemiology of America SICU: surgical intensive care unit SNF: skilled nursing facilities SSI: surgical‐site infection TFAD: time to first antibiotic dose TREAT: computerised decision support system for antibiotic treatment UBA: uncontrolled before‐after study VAP: ventilator‐associated pneumonia VRE: vancomycin‐resistant enterococci