Quantity metrics and proxy indicators to estimate the volume and appropriateness of antibiotics prescribed in French nursing homes: a cross-sectional observational study based on 2018 reimbursement data.

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Quantity metrics and proxy indicators to estimate the volume and appropriateness of antibiotics prescribed in French nursing homes: a cross-sectional observational study based on 2018 reimbursement data.

Clin Infect Dis. 2020 Aug 21;:

Authors: Simon M, Pereira O, Hulscher ME, Schouten J, Thilly N, Pulcini C

Abstract
BACKGROUND: Antibiotic resistance is an increasing threat to public health globally. Indicators on antibiotic prescribing are required to guide antibiotic stewardship interventions in nursing homes. However, such indicators are not available in the literature. Our main objective was to provide a set of quantity metrics and proxy indicators to estimate the volume and appropriateness of antibiotic use in nursing homes.
METHODS: Recently published articles were first used to select quantity metrics and proxy indicators, that were adapted to the French nursing home context. A cross-sectional observational study was then conducted based on reimbursement databases. We included all community-based nursing homes of the Lorraine region in north-eastern France. We presented descriptive statistics for quantity metrics and proxy indicators. For proxy indicators, we also assessed performance scores, clinimetric properties (measurability, applicability, and room for improvement), and conducted case-mix and cluster analyses.
RESULTS: 209 nursing homes were included. We selected fifteen quantity metrics and eleven proxy indicators of antibiotic use. The volume of antibiotic use varied hugely between nursing homes. Proxy indicators' performance scores were low, and variability between nursing homes was high for all indicators, highlighting an important room for improvement. Six out of the eleven proxy indicators had good clinimetric properties. Three distinct clusters were identified according to the number of proxy indicators for which the acceptable target was reached.
CONCLUSION: This set of fifteen quantity metrics and eleven proxy indicators may be adapted to other contexts and could be used to guide antibiotic stewardship programmes in nursing homes.

PMID: 32822471 [PubMed - as supplied by publisher]