title: Development of quality indicators for antimicrobial treatment in adults with sepsis.
abstract: BACKGROUND
  Outcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate. Several studies have shown that adherence to guidelines dictating appropriate antimicrobial use positively influences clinical outcome, shortens length of hospital stay and contributes to the containment of antibiotic resistance.Quality indicators (QIs) can be systematically developed from these guidelines to define and measure appropriate antimicrobial use. We describe the development of a concise set of QIs to assess the appropriateness of antimicrobial use in adult patients with sepsis on a general medical ward or Intensive Care Unit (ICU).
  
  
  METHODS
  A RAND-modified, five step Delphi procedure was used. A multidisciplinary panel of 14 experts appraised and prioritized 40 key recommendations from within the Dutch national guideline on antimicrobial use for adult hospitalized patients with sepsis (http://www.swab.nl/guidelines). A procedure to select QIs relevant to clinical outcome, antimicrobial resistance and costs was performed using two rounds of questionnaires with a face-to-face consensus meeting between the rounds over a period of three months.
  
  
  RESULTS
  The procedure resulted in the selection of a final set of five QIs, namely: obtain cultures; prescribe empirical antimicrobial therapy according to the national guideline; start intravenous drug therapy; start antimicrobial treatment within one hour; and streamline antimicrobial therapy.
  
  
  CONCLUSIONS
  This systematic, stepwise method, which combined evidence and expert opinion, led to a concise and therefore feasible set of QIs for optimal antimicrobial use in hospitalized adult patients with sepsis. The next step will entail subjecting these quality indicators to an applicability test for their clinimetric properties and ultimately, using these QIs in quality-improvement projects. This information is crucial for antimicrobial stewardship teams to help set priorities and to focus improvement.
authors.affiliation: Department of Internal Medicine, division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) Academic Medical Center, Meibergdreef 9, 1105, AZ Amsterdam Zuidoost, The Netherlands. c.m.vandenbosch@amc.uva.nl.
authors.forename: Caroline M A
authors.initials: CM
authors.lastname: van den Bosch
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: Stephanie
authors.initials: S
authors.lastname: Natsch
authors.forename: Inge C
authors.initials: IC
authors.lastname: Gyssens
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003697:Delphi Technique; D006801:Humans; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000592:standards*; D012107:Research Design; D018805:Sepsis / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000890:Anti-Infective Agents