Quality indicators for responsible antibiotic use in the inpatient setting: a systematic review followed by an international multidisciplinary consensus procedure

Abstract

BackgroundThis study was conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project and aimed to develop generic quality indicators (QIs) for responsible antibiotic use in the inpatient setting.MethodsA RAND-modified Delphi method was applied. First, QIs were identified by a systematic review. A complementary search was performed on web sites of relevant organizations. Duplicates were removed and disease and patient-specific QIs were combined into generic indicators. The relevance of these QIs was appraised by a multidisciplinary international stakeholder panel through two questionnaires and an in-between consensus meeting.ResultsThe systematic review retrieved 70 potential generic QIs. The QIs were appraised by 25 international stakeholders with diverse backgrounds (medical community, public health, patients, antibiotic research and development, regulators, governments). Ultimately, 51 QIs were selected in consensus. QIs with the highest relevance score included: (i) an antibiotic plan should be documented in the medical record at the start of the antibiotic treatment; (ii) the results of bacteriological susceptibility testing should be documented in the medical record; (iii) the local guidelines should correspond to the national guidelines but should be adapted based on local resistance patterns; (iv) an antibiotic stewardship programme should be in place at the healthcare facility; and (v) allergy status should be taken into account when antibiotics are prescribed.ConclusionsThis systematic and stepwise method combining evidence from literature and stakeholder opinion led to multidisciplinary international consensus on generic inpatient QIs that can be used globally to assess the quality of antibiotic use.

Quality indicators assessing antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure

“… 10 , 16 , 17 This review is reported following the PRISMA statement. 18 This literature review was conducted alongside five other literature reviews, on responsible use of antibiotics, 19 variation in antibiotic use, 20 QIs for the inpatient setting, 21 quantity metrics for the outpatient setting 22 and quantity metrics for the inpatient setting. 23 …”

“…The selection process of the stakeholders is described elsewhere. 21 The complete list of stakeholders is presented in the Acknowledgements section and full details are available in Table S2 .…”

Variation in antibiotic use among and within different settings: a systematic review

“…This systematic review of the literature was conducted as part of the European DRIVE-AB project and its primary objective was to describe the variation in use of antibiotics in outpatient and inpatient settings. 1 Further systematic reviews in the context of DRIVE-AB aimed to specifically assess the definition of responsible use of antibiotics 14 and to assess quantity metrics and quality indicators for antimicrobial use in the inpatient 15 , 16 and outpatient settings. 17 , 18 …”

Ensuring Antibiotic Development, Equitable Availability, and Responsible Use of Effective Antibiotics: Recommendations for Multisectoral Action

“…The importance of infection prevention and control in parallel to ABS activities to limit the emergence and spread of resistant bacteria as well as reduce the use of antibiotics is largely recognized. The DRIVE-AB project developed quantity metrics and quality indicators to assess antibiotic use for both inpatient and outpatient care settings that should guide ABS activities [26][27][28][29]. In the Netherlands, since 2014, all hospitals are required by the Health Care Inspectorate and the Minister of Health to establish an antimicrobial stewardship team [30].…”