title: Quality indicators to measure appropriate antibiotic use in hospitalized adults.
abstract: BACKGROUND
  An important requirement for an effective antibiotic stewardship program is the ability to measure appropriateness of antibiotic use. The aim of this study was to develop quality indicators (QIs) that can be used to measure appropriateness of antibiotic use in the treatment of all bacterial infections in hospitalized adult patients.
  
  
  METHODS
  A RAND-modified Delphi procedure was used to develop a set of QIs. Potential QIs were retrieved from the literature. In 2 questionnaire mailings with an in-between face-to-face consensus meeting, an international multidisciplinary expert panel of 17 experts appraised and prioritized these potential QIs.
  
  
  RESULTS
  The literature search resulted in a list of 24 potential QIs. Nine QIs describing recommended care at patient level were selected: (1) take 2 blood cultures, (2) take cultures from suspected sites of infection, (3) prescribe empirical antibiotic therapy according to local guideline, (4) change empirical to pathogen-directed therapy, (5) adapt antibiotic dosage to renal function, (6) switch from intravenous to oral, (7) document antibiotic plan, (8) perform therapeutic drug monitoring, and (9) discontinue antibiotic therapy if infection is not confirmed. Two QIs describing recommended care at the hospital level were also selected: (1) a local antibiotic guideline should be present, and (2) these local guidelines should correspond to the national antibiotic guidelines.
  
  
  CONCLUSIONS
  The selected QIs can be used in antibiotic stewardship programs to determine for which aspects of antibiotic use there is room for improvement. At this moment we are testing the clinimetric properties of these QIs in 1800 hospitalized patients, in 22 Dutch hospitals.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam.
authors.forename: Caroline M A
authors.initials: CM
authors.lastname: van den Bosch
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.affiliation: Department of Clinical Pharmacology.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Natsch
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Department of Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D004358:Drug Therapy / Q000379:methods / Q000592:standards; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D019984:Quality Indicators, Health Care
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic stewardship; antibiotic treatment; appropriate antibiotic use; quality improvement; quality indicator