Integrating Infectious Disease Experts into Primary Care Antibiotic Stewardship: A Multicentre, Cluster-Randomised, Outcome-Assessor-Blinded Trial.

OBJECTIVE

To assess the impact of integrating infectious disease (ID) experts into primary care antimicrobial stewardship (AMS) programmes on antibiotic consumption and prescribing adequacy for upper respiratory tract infections (URTIs) and urinary tract infections (UTIs).

METHODS

A multicentre, cluster-randomised trial across six primary care centres in Catalonia, Spain. All centres implemented a standard AMS programme, with three randomised to an advanced AMS (receiving ID expert support via a telephone helpline and biweekly meetings). The primary endpoint was total antibiotic consumption (defined daily doses per 1,000 inhabitants per day [DID]). Secondary endpoints included unnecessary and inadequate prescriptions, and 30-day reconsultations or hospitalisations, evaluated through point-prevalence surveys in patients aged over 14 years with URTI or UTI.

RESULTS

Between October 2021 and March 2023, overall antibiotic consumption increased from 7.08 (SD 1.29) to 7.79 (SD 1.65) DID (mean difference +0.71 [95% CI 0.13;1.28]). This rise was lower under advanced AMS, from 7.16 (SD 1.33) to 7.56 (SD 1.44) DID (+0.40 [95% CI -0.40;1.20]) than standard AMS, from 7.00 (SD 1.29) to 8.01 (SD 1.82) DID (+1.01 [95% CI 0.15;1.88]). During the intervention, Poisson regression showed a 4% monthly DID increase (IRR 1.04 [95% CI 1.01;1.06]), without intergroup differences (IRR 0.95 [95% CI 0.19;4.74]). Across 1,389 URTI/UTI episodes, 25.0% of prescriptions were unnecessary and 50.3% of indicated treatments were inadequate. By intervention end, advanced AMS reduced unnecessary (21.2% vs 28.3%; OR 0.68 [95% CI 0.51;0.91]) and inadequate prescriptions (38.8% vs 52.9%; OR 0.54 [95% CI 0.36;0.81]) compared with standard AMS. Reconsultations or hospitalisations showed no significant differences.

CONCLUSION

Integrating ID experts into primary care AMS did not demonstrate a statistically significant reduction in total antibiotic use. However, the data suggest a positive impact on prescribing quality without compromising patient safety. Health policymakers should consider embedding ID expertise within primary care AMS frameworks.