Quality Improvement Intervention to Reduce Antimicrobial Use in Intensive Care Units in Brazil

What this Trial Is About

This research aims to evaluate whether an educational quality improvement intervention focused on antimicrobial stewardship can reduce antimicrobial use in adult patients admitted to intensive care units (ICUs) in Brazil. The study compares current ICU practices with those after implementing the intervention, which is based on up-to-date guidelines and aims to promote rational antimicrobial use without increasing ICU mortality or length of stay. The trial uses a stepped-wedge cluster randomized design across 10 ICUs participating in the IMPACTO-MR registry platform. The intervention includes educational sessions, cognitive aids for ICU physicians and healthcare professionals to improve decisions on antimicrobial initiation and duration, and monthly audits with feedback to the ICU teams. Each ICU starts with a control phase of usual care, then transitions to the intervention phase approximately monthly starting July 2025. The study also includes a baseline data collection period before the intervention and a phase-out period to assess lasting effects after stopping feedback. Participants are all adult patients admitted to the participating ICUs during the study. Researchers will collect monthly one-day point-prevalence surveys on antimicrobial use and monitor ICU mortality rates and length of stay over 14 months to evaluate outcomes. The study will assess the impact of the educational intervention on antimicrobial use while ensuring patient safety, with no individual informed consent required due to cluster-level data collection and minimal risk.

Quality Improvement Intervention for a Safe Antimicrobial Use Reduction in Critically Ill Patients