AN ASSESSMENT OF QUALITY INDICATORS FOR APPROPRIATE ANTIBIOTIC USE [Epidemiology and Surveillance]

One of the critical elements of antimicrobial stewardship programs is the ability to measure the quality of antibiotic prescription. The aim of the present study was to evaluate the performance properties of a set of previously developed quality indicators (QIs) and to identify the potential room for improvement in antibiotic use in our setting. A monthly cross sectional point prevalence survey was conducted in a 400-bed acute care teaching hospital from June to November 2015. All adult patients treated at least 24 hours with antibiotic therapy for a suspected hospital or community-acquired bacterial infection were included. Performance scores (adherence, room for improvement, inter-observer reliability and applicability) were calculated for eight QIs.

Three hundred sixty two patients were evaluated. Adherence to the whole set of QIs was accomplished in 14.1% of evaluable patients. The QIs with a higher room for improvement were: adequate request of blood cultures (60.6%), therapeutic drug monitoring (TDM) (59.1%), sequential antibiotic therapy within 72 hours (48.2%) and empirical antibiotic therapy according to the local guideline (30.4%). The rate of patients under unnecessary antibiotic treatment in the absence of clinical or microbiological evidence of infection after 5 days was 12.2%. All indicators scored kappa's ≥ 0.6, suggesting good inter-observer reliability. Low applicability (6.1% of reviewed patients) only was found for the TDM QI. The QIs analyzed were found to be applicable, showed a good inter-observer reliability and were useful tools to identify areas with potential room for improvement in antibiotic use.

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