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

Annelie Monnier 1, 2 Jeroen Schouten 1 Marion Le Maréchal 3 Gianpiero Tebano 3 Céline Pulcini 3, 4 Mirjana Stanić Benić 5 Vera Vlahović-Palĉevski 5 Romina Milanič 5 Niels Adriaenssens 6 Ann Versporten 6 Benedikt Huttner 7 Veronica Zanichelli 7 Marlies Hulscher 1 Inge Gyssens 1, 2 Ad Antonisse Bojana Beović 8 Michael Borg Franky Buyle Marco Cavaleri 9 Harpal Dhillon Catherine Dumartin 10 Richard Drew David Findlay Abdul Ghafur Lindsay Grayson Elizabeth Hermsen Lauri Hicks Philip Howard Mike Kenston Aaron Kesselheim Charles Knirsch Patrick Lacor Ramanan Laxminarayan 11 Mical Paul 12 Diamantis Plachouras 13 Garyfallia Poulakou Christian Rabaud 4 John Rex Jesús Rodríguez-Baño 14 Arjun Srinivasan Cecilia Stålsby Lundborg Thomas Tängdén Visanu Thamlikitkul Alexandra Waluszewski 15 Sally Wellsteed Heiman Wertheim 16 Claudia Wild 
Abstract : Background: This 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. Methods: A 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. Results: The 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. Conclusions: This 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.
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Submitted on : Wednesday, November 13, 2019 - 10:54:58 AM
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Annelie Monnier, Jeroen Schouten, Marion Le Maréchal, Gianpiero Tebano, Céline Pulcini, et al.. Quality indicators for responsible antibiotic use in the inpatient setting: a systematic review followed by an international multidisciplinary consensus procedure. Journal of Antimicrobial Chemotherapy, 2018, 73 (suppl 6), pp.vi30-vi39. ⟨10.1093/jac/dky116⟩. ⟨hal-02361025⟩



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