title: Appropriate antibiotic use for patients with complicated urinary tract infections in 38 Dutch Hospital Departments: a retrospective study of variation and determinants.
abstract: BACKGROUND
  Appropriate antibiotic use in patients with complicated urinary tract infections can be measured by a valid set of nine quality indicators (QIs). We evaluated the performance of these QIs in a national setting and investigated which determinants influenced appropriate antibiotic use. For the latter, we distinguished patient, department and hospital characteristics, including organizational interventions aimed at improving the quality of antibiotic use (antibiotic stewardship elements).
  
  
  METHODS
  A retrospective, observational multicentre study included 1964 patients (58% male sex) with a complicated urinary tract infection treated at Internal Medicine and Urology departments of 19 Dutch university and non-university hospitals. Data of 50 patients per department were extracted from medical charts. QI performance scores were calculated using previously constructed algorithms. Department and hospital characteristics were collected using questionnaires filled in by an internal medicine physician and an urologist. Regression analysis was performed to identify determinants of QI performance. Clustering at department and hospital level was taken into account through inclusion of random effects in a multi-level model.
  
  
  RESULTS
  Median QI performance of departments varied between 31% ('Treat urinary tract infection in men according to local guideline') and 77% ('Perform urine culture'). The patient characteristics non-febrile urinary tract infection, female sex and presence of a urinary catheter were negatively associated with performance on many QIs. The presence of an infectious diseases physician and an antibiotic formulary were positively associated with 'Prescribe empirical therapy according to guideline'. No other department or hospital characteristics, including stewardship elements, were consistently associated with better QI performance.
  
  
  CONCLUSIONS
  A large inter-department variation was demonstrated in the appropriateness of antibiotic use. In particular certain patient characteristics (more than department or hospital characteristics) influenced the quality of antibiotic use. Some, but not all antibiotic stewardship elements did translate into better QI performance.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands. v.spoorenberg@amc.nl.
authors.forename: V
authors.initials: V
authors.lastname: Spoorenberg
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands. s.e.geerlings@amc.uva.nl.
authors.forename: S E
authors.initials: SE
authors.lastname: Geerlings
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, The Netherlands. r.b.geskus@amc.uva.nl.
authors.forename: R B
authors.initials: RB
authors.lastname: Geskus
authors.affiliation: Department of Urology, Academic Medical Centre, Amsterdam, The Netherlands. t.m.dereyke@amc.uva.nl.
authors.forename: T M
authors.initials: TM
authors.lastname: de Reijke
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands. j.m.prins@amc.uva.nl.
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.hulscher@iq.umcn.nl.
authors.forename: M E J L
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006748:Hospital Departments; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy*; D014556:Urine / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents