988. Development of Generic Quality Indicators for Antibiotic Treatment in Hospitalized Adults
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA- generieke QI - 17-9-13.pdf (204.3 kB)
  • Background:

    Antimicrobial resistance is a growing worldwide problem, with antibiotic use being its most important driving force. Antimicrobial stewardship programs can result in better antimicrobial use and an improvement in patient care. An important requirement for an effective stewardship program is the ability to measure the quality of antibiotic care, in order to be able to monitor the impact of education and interventions on antibiotic use. Quality indicators (QIs) are measurable elements which can be used to assess the actual quality of antibiotic care provided. The aim of this study was to develop QIs which can accurately measure quality of antibiotic use in all hospitalized adults treated for a bacterial infection. At this moment such QIs are not available.


    A RAND-modified Delphi procedure (a systematic, stepwise method combining evidence and expert opinion) was used. Potential QIs were retrieved from scientific literature. An international multidisciplinary expert panel appraised and prioritized the QIs regarding relevance to clinical outcome, antimicrobial resistance and costs, in two questionnaire mailings with an in-between face-to-face consensus meeting.


    Our literature search resulted in a list of 24 potential QIs. The 17 experts appraised and prioritized these potential QIs. After the first questionnaire, 9 QIs were deselected. Finally, after the second questionnaire, 2 structure and 9 process QIs were selected. The process QIs were: 1) take two blood cultures, 2) take cultures from suspected sites of infection, 3) prescribe empirical antibiotic therapy according to the local guideline, 4) streamline antibiotic therapy, 5) adapt antibiotic dosage to renal function, 6) IV-oral switch after 48-72 hours, 7) document antibiotic plan in case notes, 8) therapeutic drug monitoring, and 9) de-escalation of antibiotic therapy.


    These QIs can be used in antimicrobial stewardship programs to monitor the actual quality of antibiotic use in all hospitalized adults treated for a bacterial infection. At this moment we are testing the performance of these QIs in 1,800 hospitalized patients, in 22 Dutch hospitals.

    Caroline M.A. Van Den Bosch, MD1, Marlies E.J.L. Hulscher, Professor2, Stephanie Natsch, PhD3, Jan M. Prins, Professor, MD1 and Suzanne Geerlings, MD, PhD1, (1)Internal Med., Infectious Diseases, Tropical Med. and AIDS, Ctr. for Infection and Immunity Amsterdam (CINIMA), Academic Med. Ctr., Amsterdam, Netherlands, (2)Scientific Institute for Quality of Healthcare, Radboud Univ. Nijmegen Med. Ctr., Nijmegen, Netherlands, (3)Farmacy, Radboud Univ. Nijmegen Med. Ctr., Nijmegen, Netherlands


    C. M. A. Van Den Bosch, None

    M. E. J. L. Hulscher, None

    S. Natsch, None

    J. M. Prins, None

    S. Geerlings, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.