title: Applicability of generic quality indicators for appropriate antibiotic use in daily hospital practice: a cross-sectional point-prevalence multicenter study.
abstract: The ability to monitor the appropriateness of hospital antibiotic use is a key element of an effective antibiotic stewardship program. A set of 11 generic quality indicators (QIs) was previously developed to assess the quality of antibiotic use in hospitalized adults treated for a bacterial infection. The primary aim of the current study was to assess the clinimetric properties of these QIs (nine process and two structure indicators) in daily clinical practice. In a cross-sectional point-prevalence survey, performed in 2011 and 2012, 1890 inpatients from 22 hospitals in the Netherlands treated with antibiotics for a suspected bacterial infection were included, and data were extracted from medical records. In this cohort we tested the measurability, applicability, reliability, room for improvement and case mix stability of the previously developed QIs. Low applicability (≤10% of reviewed patients) was found for the QIs 'therapeutic drug monitoring', 'adapting antibiotics to renal function' and 'discontinue empirical therapy in case of lack of clinical and/or microbiological evidence of infection'. For the latter, we also found a low inter-observer agreement (kappa <0.4). One QI showed low improvement potential. The remaining seven QIs had sound clinimetric properties. Case-mix correction was necessary for most process QIs. For all QIs, we found ample room for improvement and large variation between hospitals. Establishing the clinimetric properties was essential, as four of the 11 previously selected QIs showed unsatisfactory properties in this practice test. Since the quality of antibiotic use and the process of documenting data is changing over time and may vary per country, QIs should always be tested in practice first.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: c.m.vandenbosch@amc.nl.
authors.forename: C M A
authors.initials: CM
authors.lastname: van den Bosch
authors.affiliation: Department of Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: M E J L
authors.initials: ME
authors.lastname: Hulscher
authors.affiliation: Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Natsch
authors.affiliation: Department of Centre for Infectious Diseases Epidemiology and Surveillance, The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wille
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: S E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008499:Medical Records / Q000706:statistics & numerical data; D009426:Netherlands; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic stewardship; Appropriate antibiotic use; Clinimetric properties; Quality improvement; Quality indicator