title: Assessing appropriateness of antimicrobial therapy: in the eye of the interpreter.
abstract: To address the increase of drug-resistant bacteria and widespread inappropriate use of antimicrobials, many healthcare institutions have implemented antimicrobial stewardship programs to promote appropriate use of antimicrobials and optimize patient outcomes. However, a consensus definition of appropriate use is lacking. We conducted a multicenter observational study to compare 4 definitions of appropriateness--a study site-specific definition, use supported by susceptibility data, use supported by electronic drug information resources (Clinical Pharmacology/Micromedex), or study site principal investigator (PI) opinion-among patients receiving 1 or more of 13 identified antimicrobials. Data were collected for 262 patients. Overall, appropriateness with the 4 definitions ranged from 79% based on PI opinion to 94% based on susceptibility data. No single definition resulted in consistently high appropriate use for all target antimicrobials. For individual antimicrobials, the definitions with the highest rate of appropriate use were Clinical Pharmacology/Micromedex support (6 of 7 antimicrobials) and susceptibility data (5 of 7 antimicrobials). For specific indications, support from susceptibility data resulted in the highest rate of appropriate use (4 of 7 indications). Overall comparisons showed that appropriateness assessed by PI opinion differed significantly compared with other definitions when stratified by either target antimicrobial or indication. The significant variability in the rate of appropriate use highlights the difficulty in developing a standardized definition that can be used to benchmark judicious antimicrobial use.
authors.affiliation: Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
authors.forename: Daryl D
authors.initials: DD
authors.lastname: DePestel
authors.affiliation: Department of Pharmacy, Huntsville Hospital, Alabama.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Eiland
authors.affiliation: Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center, Little Rock.
authors.forename: Katherine
authors.initials: K
authors.lastname: Lusardi
authors.affiliation: Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Destache
authors.affiliation: College of Pharmacy, University of New Mexico, Albuquerque.
authors.forename: Renée-Claude
authors.initials: RC
authors.lastname: Mercier
authors.affiliation: Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McDaneld
authors.affiliation: Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Lamp
authors.affiliation: Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Chung
authors.affiliation: Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Hermsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial prescribing behavior; antimicrobial stewardship program; antimicrobial therapy; observational study