Implementation of French Recommendations for the Prevention and the Treatment of Hospital-acquired Pneumonia: A Cluster-randomized Trial
Antoine Roquilly, Gérald Chanques, Sigismond Lasocki, Arnaud Foucrier, Brice Fermier, Hugues de Courson, C. Carrié, Marc Danguy des Déserts, Clément Gakuba, Jean‐Michel Constantin, Kevin Lagarde, Mathilde Holleville, Sami Blidi, Achille Sossou, Pauline Cailliez, Céline Monard, Adrien Oudotte, Calypso Mathieu, Jérémy Bourenne, C. Isetta, Pierre-François Pérrigault, Karim Lakhal, Armine Rouhani, Karim Asehnoune, Philippe Guerci, Alexy Tran‐Dinh, Benjamin G. Chousterman, Alexandru Cupaciu, Claire Dahyot‐Fizelier, Rémy Bellier, Jonathan Duong, Alexandre Mansour, Jérôme Morel, Ghilain Beauplet, Marie‐Anne Vibet, Fanny Feuillet, Véronique Sebille, Marc Léone
Abstract
BACKGROUND: We determined whether an audit on the adherence to guidelines for hospital-acquired pneumonia (HAP) can improve the outcomes of patients in intensive care units (ICUs). METHODS: This study was conducted at 35 ICUs in 30 hospitals. We included consecutive, adult patients hospitalized in ICUs for 3 days or more. After a 3-month baseline period followed by the dissemination of recommendations, an audit on the compliance to recommendations (audit period) was followed by a 3-month cluster-randomized trial. We randomly assigned ICUs to either receive audit and feedback (intervention group) or participate in a national registry (control group). The primary outcome was the duration of ICU stay. RESULTS: Among 1856 patients enrolled, 602, 669, and 585 were recruited in the baseline, audit, and intervention periods, respectively. The composite measures of compliance were 47% (interquartile range [IQR], 38-56%) in the intervention group and 42% (IQR, 25-53%) in the control group (P = .001). As compared to the baseline period, the ICU lengths of stay were reduced by 3.2 days in the intervention period (P = .07) and by 2.8 days in the control period (P = .02). The durations of ICU stay were 7 days (IQR, 5-14 days) in the control group and 9 days (IQR, 5-20 days) in the intervention group (P = .10). After adjustment for unbalanced baseline characteristics, the hazard ratio for being discharged alive from the ICU in the control group was 1.17 (95% confidence interval, .69-2.01; P = .10). CONCLUSIONS: The publication of French guidelines for HAP was associated with a reduction of the ICU length of stay. However, the realization of an audit to improve their application did not further improve outcomes. CLINICAL TRIALS REGISTRATION: NCT03348579.