Quality indicators assessing antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure
Marion Le Maréchal
(1)
,
Gianpiero Tebano
(1)
,
Annelie Monnier
(2, 3)
,
Niels Adriaenssens
(4, 5)
,
Inge Gyssens
(2, 3)
,
Benedikt Huttner
(6)
,
Romina Milanič
(7)
,
Jeroen Schouten
(2)
,
Mirjana Stanić Benić
(7)
,
Ann Versporten
(4)
,
Vera Vlahović-Palčevski
(7)
,
Veronica Zanichelli
(6)
,
Marlies Hulscher
(2)
,
Céline Pulcini
(1, 8)
,
Bojana Beović
(9)
,
Luis Bavestrello
,
Jon Cohen
,
Pieter-Jan Cortoos
,
Harpal Dhillon
,
Richard Drew
,
Prabhavathi Fernandes
,
David Findlay
,
Ian Friedland
,
Ian Gould
,
Lauri Hicks
,
Christopher Longshaw
,
Carl Llor
,
Allison Mcgeer
,
Iruka Okeke
,
Diamantis Plachouras
(10)
,
Garyfallia Poulakou
,
John Rex
,
Thomas Tängdén
,
Laura Trolle Saust
,
Claudine Richon
,
France Roblot
(11)
,
Robert Vander Stichele
,
Marcel Verweij
,
Heiman Wertheim
(12)
1
APEMAC -
Maladies chroniques, santé perçue, et processus d'adaptation
2 Radboud University Medical Center [Nijmegen]
3 UHasselt - Hasselt University
4 VAXINFECTIO - Vaccine & Infectious Disease Institute [Antwerp, Belgium]
5 UA - University of Antwerp
6 Geneva University Hospitals and Geneva University
7 University Hospital Rijeka
8 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
9 University of Ljubljana
10 Fourth Department of Medicine
11 Univ Hosp Poitiers, Dept Infect Dis
12 OUCRU - Oxford University Clinical Research Unit [Ho Chi Minh City]
2 Radboud University Medical Center [Nijmegen]
3 UHasselt - Hasselt University
4 VAXINFECTIO - Vaccine & Infectious Disease Institute [Antwerp, Belgium]
5 UA - University of Antwerp
6 Geneva University Hospitals and Geneva University
7 University Hospital Rijeka
8 Service des Maladies Infectieuses et Tropicales [CHRU Nancy]
9 University of Ljubljana
10 Fourth Department of Medicine
11 Univ Hosp Poitiers, Dept Infect Dis
12 OUCRU - Oxford University Clinical Research Unit [Ho Chi Minh City]
Benedikt Huttner
- Function : Author
- PersonId : 797155
- ORCID : 0000-0002-1749-9464
Jeroen Schouten
- Function : Author
- PersonId : 780975
- ORCID : 0000-0001-9118-4420
Marlies Hulscher
- Function : Author
- PersonId : 797154
- ORCID : 0000-0002-2160-4810
Luis Bavestrello
- Function : Author
Jon Cohen
- Function : Author
Pieter-Jan Cortoos
- Function : Author
Harpal Dhillon
- Function : Author
Richard Drew
- Function : Author
Prabhavathi Fernandes
- Function : Author
David Findlay
- Function : Author
Ian Friedland
- Function : Author
Ian Gould
- Function : Author
Lauri Hicks
- Function : Author
Christopher Longshaw
- Function : Author
Carl Llor
- Function : Author
Allison Mcgeer
- Function : Author
Iruka Okeke
- Function : Author
Garyfallia Poulakou
- Function : Author
John Rex
- Function : Author
Thomas Tängdén
- Function : Author
Laura Trolle Saust
- Function : Author
Claudine Richon
- Function : Author
Robert Vander Stichele
- Function : Author
Marcel Verweij
- Function : Author
Abstract
Objectives: Quality indicators (QIs) assessing the appropriateness of antibiotic use are essential to identify targets for improvement and guide antibiotic stewardship interventions. The aim of this study was to develop a set of QIs for the outpatient setting from a global perspective.
Methods: A systematic literature review was performed by searching MEDLINE and relevant web sites in order to retrieve a list of QIs. These indicators were extracted from published trials, guidelines, literature reviews or consensus procedures. This evidence-based set of QIs was evaluated by a multidisciplinary, international group of stakeholders using a RAND-modified Delphi procedure, using two online questionnaires and a face-to-face meeting between them. Stakeholders appraised the QIs' relevance using a nine-point Likert scale. This work is part of the DRIVE-AB project.
Results: The systematic literature review identified 43 unique QIs, from 54 studies and seven web sites. Twenty-five stakeholders from 14 countries participated in the consensus procedure. Ultimately, 32 QIs were retained, with a high level of agreement. The set of QIs included structure, process and outcome indicators, targeting both high- and middle- to low-income settings. Most indicators focused on general practice, addressing the common indications for antibiotic use in the community (particularly urinary and respiratory tract infections), and the organization of healthcare facilities. Twelve indicators specifically addressed outpatient parenteral antimicrobial therapy (OPAT).
Conclusions: We identified a set of 32 outpatient QIs to measure the appropriateness of antibiotic use. These QIs can be used to identify targets for improvement and to evaluate the effects of antibiotic stewardship interventions.