In the Journals

Quality indicators may be useful for antibiotic stewardship

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November 10, 2014

Quality indicators could help determine areas for improvement of antibiotic use among hospitalized patients, according to new data.

“Our set of generic [quality indicators] provides important parameters which can be used to measure the various steps in the process of antibiotic use on patient level … along the entire antibiotic pathway,” the researchers said. “These [quality indicators] enable stewardship teams to determine for which steps along the antibiotic pathway there is room for improvement, and to set priorities for targeted improvement actions in their specific hospital.

Caroline M.A. van den Bosch, MD, of the Academic Medical Center, University of Amsterdam, and colleagues used a RAND-modified Delphi method to develop a set of quality indicators (QIs) for antibiotic use in hospitalized adult patients. The researchers identified 24 potential generic QIs through a literature review, which were put into a questionnaire for review by a 17-member panel. Subsequently, five panel members attended a consensus meeting for discussion, yielding 11 potential quality indicators. These were forwarded to the panel in a second questionnaire for final review and approval.

The QIs include: obtain two blood cultures; obtain cultures from suspected areas of infection; use local guidelines to prescribe an empirical antibiotic regimen; switch empirical antibiotics to pathogen-directed treatment as soon as culture results are available; and adjust dose and dosing duration of antibiotics to renal function.

The also include: switch antibiotic therapy from IV to oral after 48 to 72 hours based on the clinical condition; chronicle the antibiotic plan; monitor the therapeutic drug regimen; cease antibiotic therapy if the infection is not confirmed; have a current, local antibiotic guideline; and ensure the local guideline corresponds to national guidelines.

The researchers said the clinimetric value of the QIs is currently being tested in 1,800 patients in 22 Dutch hospitals.

“The applicability of QIs should always be tested in practice first, since registration of data is different in every country, which affects the feasibility, validity and reliability of data collection,” the researchers wrote. “Also within a country, registration may vary between and sometimes even within clinical settings.”

Disclosure: Three researchers received a research grant for this study from the Netherlands Organisation for Health Research and Development (Zon/MW).

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