Spaced Education for Antimicrobial Stewardship Effectively Increases Knowledge About Duplicative Anaerobic Therapy

Abstract

Background. Eliminating redundant anaerobic coverage is a key target for antimicrobial stewardship. Spaced education activities leverage a spacing effect, testing effect, and competition to optimize participation and retention. Methods. Quality improvement project using a spaced education module to improve knowledge about anaerobic antibiotics. Focused chart review was used to identify common indications in gastroenterology (GI) patients who received metronidazole concurrently with another anaerobic antibiotic on > 1 day and did not have Clostridium difficile testing or diagnosis. Based on these results, 10 multiple-choice questions were created about treatment of intra-abdominal infections, anaerobic activity of common antibiotics, and Bacteroides resistance. Test questions and answers were delivered to GI faculty and fellows at spaced intervals over 2-4 weeks; questions were retired after two correct answers. Knowledge scores were compared at initial and final question presentation using generalized estimating equations. A post-module satisfaction survey was sent to participants. Results. Over a 12-month period, 37 GI patients received >1 day of metronidazole with another anaerobic antibiotic. Median duration of redundant use was 3 days (range, 1-19). Common indications included inflammatory bowel disease (46%), intra-abdominal infection (30%), Hirschsprung-associated enterocolitis (11%), and motility disorder (11%). 56/66 (85%) GI physicians participated in the spaced education activity. Overall knowledge score increased significantly from 57% to 86% (P < 0.001). The most improvement was seen for items related to antibiotic spectrum (26% to 67%) and trends in Bacteroides resistance (47% to 90%). Of the 52% of GI physicians who responded to the post-module survey, 91% were satisfied with the activity, 100% considered the time required reasonable, and 94% expressed interest in receiving similar education modules on other aspects of antimicrobial stewardship. Conclusion. A spaced education module on duplicative anaerobic therapy increased knowledge among GI physicians and was well-received. Spaced education is a promising method to promote learning and retention for antimicrobial stewardship topics.