ESGAP inventory of target indicators assessing antibiotic prescriptions: a cross-sectional survey

Howard, Philip; Huttner, Benedikt; Beović, Bojana; Béraud, Guillaume; Kofteridis, Diamantis P.; Pardo, Jose Pano; Schouten, Jeroen; Pulcini, Céline; Angioni, Goffredo; Arvaniti, Kostoula; Barać, Aleksandra; Bolla, Cesare; Calbo, Esther; Dyar, Oliver James; Fantoni, Massimo; Fjeld, Hilde; Keuleyan, Emma; Kumar, Sathish; Harhxi, Arjan; Jenkins, David; Maurer, Florian P.; Messiaen, Peter; Baranda, M. Montejo; Muñóz, Patricia; Orlando, Gabriella; Pagani, Léonardo; Pepe, Fatmanur; Gentil, Pilar Retamar; Pereira, Nuno; Rodrigues-Bano, Jesus; Skodvin, Brita; Tängdén, Thomas; Vitrat, Virginie; Vlahović‐Palčevski, Vera; Wechsler-Fördös, Agnes; Zarb, Peter

doi:10.1093/jac/dkx243

Cited by 39 publications

(30 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The recent position paper from the Infectious Diseases Society of America (IDSA) outlines various strategies for implementing AMS in hospital settings but lacks information on AMS interventions upon hospital discharge [ 5 ]. A recent inventory survey by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Antimicrobial StewardshiP (ESGAP) reported that measurable quality (appropriateness) and quantity (volume or cost) indicators in antimicrobial prescribing are lacking in several countries and that development of such indicators would lead to more appropriate prescribing [ 12 ]. Our study assessed for quality (appropriateness) and quantity (volume) of antimicrobials prescribed upon hospital discharge, a domain where there is lack of information.…”

Section: Discussionmentioning

confidence: 99%

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

Chavada¹,

Davey

O’Connor

et al. 2018

BMC Infect Dis

View full text Add to dashboard Cite

BackgroundAntimicrobial stewardship (AMS) interventions largely target inpatient antimicrobial prescribing. Literature on appropriateness of antimicrobials prescribed at the interface between hospital and the community is minimal. This study was designed to assess the appropriateness of antimicrobials prescribed on hospital discharge and evaluate the impact of AMS interventions.MethodsPatients with discharge medications processed by the pharmacy were identified using a computerized pharmacy medication tracker over a four week period. The antimicrobials prescribed on discharge were assessed independently for appropriateness of antimicrobial choice, dose, frequency and duration. Data on various AMS interventions was collected. Univariate followed by multivariate logistic regression (MVLR) analysis was performed using SPSS V 23 (IBM, California).ResultsA total of 892 discharge prescriptions were processed by the pharmacy department, 236 of which contained antibiotic prescriptions. Of these, 74% were appropriate for antimicrobial choice, 64% for dose, 64% for frequency and 21% for duration. In particular, 71% of patients received a course in excess of Therapeutic Guidelines-Australia(TG-A) recommended length of treatment. On univariate analysis, discharge antimicrobial prescriptions were more likely to be appropriate for antimicrobial choice, frequency and duration; appropriate microbiological specimens were more likely to be taken and targeted therapy more likely to be given when the AMS team was involved. On MVLR, appropriateness with antimicrobial dosing frequency [OR 5.6(1.9–19.2)], microbiological specimens [OR 4.3(1.6–11.6)] and receipt of targeted therapy [OR 2.8(1.8–6.2)] with AMS involvement remained significant.ConclusionsA large discrepancy exists between antimicrobial regimens prescribed on hospital discharge and those recommended in consensus guidelines, particularly concerning duration of treatment. While AMS interventions are well established for improving antimicrobial prescribing in hospital inpatients, the hospital-community interface remains a challenge in terms of antimicrobial prescribing and exposes patients to potential harm. There is a clear need for AMS interventions to extend to antimicrobial therapy prescribed on discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

Chavada¹,

Davey

O’Connor

et al. 2018

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…These initiatives provide for local surveillance of antibiotic consumption, systematic measuring, evaluating & improving quality of antibiotic usage, regular training of prescribing physicians and other relevant healthcare workers in diagnostics, treatment and prophylaxis of infections, focusing on appropriate use of antimicrobial agents as well as prevention and control of antimicrobial resistance. For example some antibiotic stewardship strategies in European countries are based on educational resources (UK and Germany), on public reporting with the data on antibiotic consumption and resistance for hospital and primary care publicly available on a website (UK) or on cross-sectoral antibiotic stewardship networks implemented in different settings (hospital, primary care, long-term care facilities) and at local, regional and national levels (Sweden France, Spain) [ 4 , 5 ]. Reliable and comparable data on the patterns of national antibiotic drug use and distribution are the starting point for analyzing the antibiotic resistance problem.…”

Section: Introductionmentioning

confidence: 99%

Predictors and trajectories of antibiotic consumption in 22 EU countries: Findings from a time series analysis (2000–2014)

et al. 2018

View full text Add to dashboard Cite

BackgroundThis study analyzes the trajectories of antibiotic consumption using different indicators of patients’ socioeconomic status, category and age-group of physicians.MethodsThis study uses a pooled, cross-sectional, time series analysis. The data focus on 22 European countries from 2000 to 2014 and were obtained from the European Center for Disease and Control, Organization for Economic Co-operation and Development, Eurostat and Global Economic Monitor.ResultsThere are large variations in community and hospital use of antibiotics in European countries, and the consumption of antibiotics has remained stable over the years. This applies to the community (b = 0.07, p = 0.267, 95% -0.06, 0.19, b-squared <0.01, p = 0.813, 95% = -0.01, 0.02) as well as the hospital sector (b = -0.02; p = 0.450; CI 95% = -0.06, 0.03; b-squared <0.01; p = 0.396; CI95% = > -0.01, <0.01). Some socioeconomic variables, such as level of education, income, Gini index and unemployment, are not related to the rate of antibiotic use. The age-group of physicians and general practitioners is associated with the use of antibiotics in the hospital. An increase in the proportion of young doctors (<45 years old) leads to a significant increase in antibiotics consumption, and as the percentage of generalist practitioners increases, there use of antibiotics in hospitals decreases by 0.04 DDD/1000 inhabitants.ConclusionsUnderstanding that age-groups and categories (general/specialist practitioners) of physicians may predict antibiotic consumption is potentially useful in defining more effective health care policies to reduce the inappropriate antibiotic use while promoting rational use.

show abstract

“…There are currently four indicators in place in France, focusing on antibiotic prescribing, and this French programme has led to an almost 4% reduction in antibiotic prescribing for these particular indicators [ 27 ]. The English pay-for-performance ‘quality premium’ programme has achieved an 8% reduction in antibiotic prescribing, without any unintended clinical consequences [ 7 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some countries, however, use such PIs: for example, in Belgium, an amoxicillin/co-amoxiclav ratio is used, with an 80/20 target. In England, a trimethoprim to nitrofurantoin ratio is also used, but with only a relative reduction target [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Proxy indicators to estimate appropriateness of antibiotic prescriptions by general practitioners: a proof-of-concept cross-sectional study based on reimbursement data, north-eastern France 2017

Thilly

Pereira²,

Schouten

et al. 2020

Eurosurveillance

Self Cite

View full text Add to dashboard Cite

Background In most countries, including France, data on clinical indications for outpatient antibiotic prescriptions are not available, making it impossible to assess appropriateness of antibiotic use at prescription level. Aim Our objectives were to: (i) propose proxy indicators (PIs) to estimate appropriateness of antibiotic use at general practitioner (GP) level based on routine reimbursement data; and (ii) assess PIs’ performance scores and their clinimetric properties using a large regional reimbursement database. Methods A recent systematic literature review on quality indicators was the starting point for defining a set of PIs, taking French national guidelines into account. We performed a cross-sectional study analysing National Health Insurance data (available at prescriber and patient levels) on antibiotics prescribed by GPs in 2017 for individuals living in north-eastern France. We measured performance scores of the PIs and their case-mix stability, and tested their measurability, applicability, and room for improvement (clinimetric properties). Results The 3,087 GPs included in this study prescribed a total of 2,077,249 antibiotic treatments. We defined 10 PIs with specific numerators, denominators and targets. Performance was low for almost all indicators ranging from 9% to 75%, with values < 30% for eight of 10 indicators. For all PIs, we found large variation between GPs and patient populations (case-mix stability). Regarding clinimetric properties, all PIs were measurable, applicable, and showed high improvement potential. Conclusions The set of 10 PIs showed satisfactory clinimetric properties and might be used to estimate appropriateness of antibiotic prescribing in primary care, in an automated way within antibiotic stewardship programmes.

show abstract

ESGAP inventory of target indicators assessing antibiotic prescriptions: a cross-sectional survey

Abstract: National indicators, with clear targets and incentives, are not commonly used in Europe and we observed wide variations between countries regarding the selected indicators, the units of measure and the chosen targets.

Cited by 39 publications

References 2 publications

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

'Careful goodbye at the door': is there role for antimicrobial stewardship interventions for antimicrobial therapy prescribed on hospital discharge?

Predictors and trajectories of antibiotic consumption in 22 EU countries: Findings from a time series analysis (2000–2014)

Proxy indicators to estimate appropriateness of antibiotic prescriptions by general practitioners: a proof-of-concept cross-sectional study based on reimbursement data, north-eastern France 2017

Contact Info

Product

Resources

About