A digital antimicrobial stewardship smartphone application to combat AMR: the AB-assistant

Antimicrobials are an indispensable part of modern medicine. However, optimal prescription of these agents is becoming increasingly challenging because of the growing complexity of
guidelines, and constantly changing epidemiology.

AIM
To develop a digital steward for use in different countries worldwide which will increase adherence to prescription guidelines and reduce antimicrobial resistance.

In this project we propose to

1. develop an AB-assistant app based on the existing Spectrum app (Calgary) with improvements to enhance antimicrobial stewardship in large parts of the world
2. test the usability of this app in different countries to determine barriers and facilitators
3. evaluate the AB-assistant in an international, multicentre, randomized clinical trial involving centres in 4 countries in different settings with appropriate antimicrobial use as a primary outcome and
4. use factors identified in this study to facilitate further customization and worldwide implementation of AB-assistant. 

4 steps have been suggested for development of an optimal IT-based intervention. These steps represent the basis for the division of the different work packages and are:

• Development
  The basis of the app will be the Spectrum CDSS, which was originally developed in Canada. Using the Spectrum platform, hospitals are able to upload, edit and maintain their own content using a cloud based content management system (CMS) that synchronizes with iOS, Android and Web apps. Each hospital or group of hospitals in the study will customize its own content with local empiric treatment algorithms, local susceptibility data and antimicrobial information relevant to their local formulary. 
• Feasibility and piloting
  Test the interactive AB-assistant for usability in different countries with different antimicrobial resistance rates and different guidelines in pilot studies. 
• Evaluation
  Evaluate the impact of the AB-assistant in a multicentre RCT in hospitals in different countries. Alongside the RCT, a process evaluation will be performed to assess actual use of the app and experiences while using it.
• Implementation and dissemination 
  Develop and implementation plan for more countries with results of the study and international workshops.

Novelty, originality and feasibility of the project
We believe that this study proposal is highly innovative and unique by assessing a customizable app to improve antimicrobial prescribing in many different settings. The multi-country collaboration makes it not only possible to combine expertise in the field of IT-based interventions for AMS, but also to test the app under real-life circumstances in different settings. The project will thus provide an evidence-based framework for antimicrobial management that is 24/7 available on the smartphone of the prescribing physician. Lastly the large expertise of the consortium members with AMS, IT-based intervention, implementation research, behavioral sciences and clinical studies will ensure its feasibility and make this project a possible game changer in the world of AMS.

• JPI-AMR JTC 2017
• Zon MW 549003001

External collaborations

• Uppsala University, Dept of Medical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden

• Geneva University Hospitals, Division of Infectious Diseases and Infection Control Program , University of Geneva, Faculty of Medicine [UNIGE],1205 Geneva, Switzerland

• University of Calgary, Cumming School of Medicine and Alberta Health Services, Department of Medicine, AGW5, Foothills Medical Centre, T2N 2TN, Calgary, Canada

• Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare) PO Box 9101, 6500 HB Nijmegen

Prof Dr Annelies Verbon
a.verbon@erasmusmc.nl

Dr Nelianne Verkaik
n.verkaik@erasmusmc.nl

Drs. Ramzy Helou
r.helou@erasmusmc.nl