Quality indicators to measure appropriate antibiotic use in hospitalized adults.
Clin Infect Dis. 2014 Sep 28;
Authors: van den Bosch CM, Geerlings SE, Natsch S, Prins JM, Hulscher ME
BACKGROUND: An important requirement for an effective antibiotic stewardship program is the ability to measure appropriateness of antibiotic use. The aim of this study was to develop quality indicators (QIs) that can be used to measure appropriateness of antibiotic use in the treatment of all bacterial infections in hospitalized adult patients.
METHODS: A RAND-modified Delphi procedure was used to develop a set of QIs. Potential QIs were retrieved from literature. In two questionnaire mailings with an in-between face-to-face consensus meeting, an international multidisciplinary expert panel (17 experts) appraised and prioritized these potential QIs.
RESULTS: The literature search resulted in a list of 24 potential QIs. Nine QIs describing recommended care at patient level were selected: 1) take two blood cultures, 2) take cultures from suspected sites of infection, 3) prescribe empirical antibiotic therapy according to local guideline, 4) change empirical to pathogen directed therapy, 5) adapt antibiotic dosage to renal function, 6) switch from IV to oral, 7) document antibiotic plan, 8) perform therapeutic drug monitoring, 9) discontinue antibiotic therapy if infection is not confirmed. Two QIs describing recommended care at hospital level were also selected: 1) a local antibiotic guidelines should be present, and 2) these local guidelines should correspond to the national antibiotic guidelines.
CONCLUSION: The selected QIs can be used in antibiotic stewardship programs to determine for which aspects of antibiotic use there is room for improvement. At this moment we are testing the clinimetric properties of these QIs in 1,800 hospitalized patients, in 22 Dutch hospitals.
PMID: 25266285 [PubMed - as supplied by publisher]