scholarly journals The state of antibiotic stewardship programs in 2021: The perspective of an experienced steward

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Tamar F. Barlam
Keyword(s):  
Antibiotic Stewardship ◽  
Treatment Guidelines ◽  
Therapy Monitoring ◽  
Local Treatment ◽  
Antibiotic Use ◽  
Leadership Role ◽  
Transitions Of Care ◽  
Audit And Feedback ◽  
Quality Health Care ◽  
Essential Components

Abstract Recognition of antibiotic stewardship programs (ASPs) as essential components of quality health care has dramatically increased in the past decade. The value of ASPs has been further reinforced during the coronavirus disease 2019 (COVID-19) pandemic because these programs were instrumental in monitoring antibiotic use, assessing emerging COVID-19 therapies, and coordinating implementation of monoclonal antibody infusions and vaccinations. ASPs are now required across hospital settings as a condition of participation for the Centers for Medicare and Medicaid Services and for accreditation by The Joint Commission. In the 2019 National Healthcare Safety Network annual survey, almost 89% of hospitals met the Seven Core Elements for ASPs defined by the Centers for Disease Control and Prevention. More than 61% of programs were co-led by physicians and pharmacists, evidence of the leadership role of both groups. ASPs employ many strategies to improve prescribing. Core interventions of preauthorization for targeted antibiotics, prospective audit and feedback, and development of local treatment guidelines have been supplemented with numerous emerging strategies. Diagnostic stewardship, optimizing duration of therapy, promoting appropriate conversion from intravenous to oral therapy, monitoring at transitions of care and hospital discharge, implementing stewardship initiatives in the outpatient setting, and increasing use of telemedicine are approaches being adopted across hospital settings. As a core function for medical facilities, ASP leaders must ensure that antibiotic use and ASP interventions promote optimal and equitable care. The urgency of success becomes progressively greater as complex patterns of antibiotic resistance continue to emerge, exacerbated by unpredictable factors such as a worldwide pandemic.

scholarly journals Variation in Measures of Antimicrobial Use Across Four Nursing Homes, Atlanta, Georgia, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s510-s510
Author(s):  
William Dube ◽  
Sahebi Saiyed ◽  
Patricia Comer ◽  
Michael Hanichen ◽  
Christie Klinczar ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Local Treatment ◽  
Treatment Guideline ◽  
Transitions Of Care ◽  
Term Care ◽  
Start Date ◽  
Treatment Site ◽  
Days Of Therapy

Background: Although antibiotic stewardship programs (ASP) are now required in nursing homes, assimilating and responding to data to improve prescribing in nursing homes is novel. Four Atlanta-based skilled nursing facilities (SNFs) began collaborating (EASIL: Emory Antibiotic Stewardship in Long-Term Care) to share standardized prescribing data to allow interfacility comparisons and action. Methods: After SNF ASPs were evaluated and trained, standardized prescribing logs were submitted (January 2019 to June 2019) including the following data: start date, treatment site, prescriber attribution of order (ie, SNF order vs hospital order) and monthly resident days. SNF-specific point estimates of usage rates were calculated as pooled means for all antibiotic starts, SNF-order starts, and days of therapy (DOT), by treatment site per 1,000 resident days. Duration of urinary tract infection (UTI) therapy was assessed by calculating percentage of SNF-UTI starts over recommended duration defined by the local treatment guideline. Rate ratios (RRs) of use were calculated to compare SNF-specific rates to the largest SNF. The 95% CIs were calculated using normal approximation. Results: Monthly starts ranged from 124 to 177, with a pooled mean of 7.8 antibiotic starts (any type), 4.5 SNF-order starts, and 1.2 SNF-UTI starts per 1,000 resident days. Approximately half of all starts were SNF starts (range, 43%–53%), and less than half of DOT were attributed to SNF starts (range, 35%–45%). Overall, SNF-order treatment sites were most often UTIs (29%), lower respiratory infections (17%), and skin and soft-tissue infections (17%). SNF-order UTI starts per 1,000 patient days varied at 1 SNF (SNF B RR, 1.57; 95% CI, 1.04–2.36). SNF-order UTI DOT per 1,000 patient days was more variable, with SNFs B and C having significantly higher rates (B RR, 1.49, 1.24, and 1.82; C RR, 5.42; 95% CI, 4.65–6.34) than SNF A (Fig. 1). The percentage of SNF-order UTI starts that were over recommended duration ranged from 8% (nitrofurantoin, SNF A) to 100% (fluoroquinolones, SNF C) (Fig. 1). Conclusions: Although UTIs are the single most common reason to prescribe antibiotics after arriving in a SNF, they account for a small fraction of overall starts and an even smaller fraction of DOT. We identified outlier prescribing by different SNFs using 3 metrics, suggesting that distinct corrective actions are necessary to target distinct prescribing challenges (starts, duration, and transitions of care).Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.

scholarly journals Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s188-s189
Author(s):  
Jeffrey Gerber ◽  
Robert Grundmeier ◽  
Keith Hamilton ◽  
Lauri Hicks ◽  
Melinda Neuhauser ◽  
...  
Keyword(s):  
Predictive Value ◽  
Gold Standard ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Tract Infections ◽  
The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

Thinking Beyond the “Core” Antibiotic Stewardship Interventions: Shifting the Onus for Appropriate Antibiotic Use from Stewardship Teams to Prescribing Clinicians

2020 ◽  
Author(s):  
Timothy C Jenkins ◽  
Pranita D Tamma
Keyword(s):  
Antibiotic Stewardship ◽  
Paradigm Shift ◽  
Daily Practice ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prior Authorization ◽  
Prospective Audit ◽  
The Core ◽  
Primary Focus ◽  
Prospective Audit And Feedback

Abstract United States guidance for hospital antibiotic stewardship has emphasized prospective audit and feedback and prior authorization of select antibiotics as core interventions. These remain the most common interventions implemented by stewardship programs. Although these approaches have been shown to reduce unnecessary antibiotic use, they incorrectly put the onus for appropriate antibiotic use on the stewardship team rather than the prescribing clinician. We propose that a primary focus of stewardship programs should be implementation of broader interventions that engage frontline clinicians and equip them with tools to integrate antibiotic stewardship into their own daily practice, thus reducing the need for day-to-day stewardship team oversite. We discuss a framework of broader interventions and policies that will facilitate this paradigm shift.

scholarly journals VA Antibiotic Stewardship Intervention to Improve Outpatient Antibiotic Use for ARIs: A Cost-Effectiveness Analysis

2020 ◽  
Vol 41 (S1) ◽  
pp. s55-s55
Author(s):  
Minkyoung Yoo ◽  
Richard Nelson ◽  
McKenna Nevers ◽  
Karl Madaras-Kelly ◽  
Katherine Fleming-Dutra ◽  
...  
Keyword(s):  
Monte Carlo ◽  
Cost Effectiveness ◽  
Healthcare Utilization ◽  
Antibiotic Treatment ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Core Elements ◽  
Tract Infections ◽  
The Cost

Background: The Core Elements of Outpatient Antibiotic Stewardship provide a framework to improve antibiotic use, but cost-effectiveness data on interventions to improve antibiotic use are limited. Beginning in September 2017, an antibiotic stewardship intervention was launched in within 10 outpatient Veterans Healthcare Administration clinics. The intervention was based on the Core Elements and used an academic detailing (AD) and an audit and feedback (AF) approach to encourage appropriate use of antibiotics. The objective of this analysis was to evaluate the cost-effectiveness of the intervention among patients with uncomplicated acute respiratory tract infections (ARI). Methods: We developed an economic simulation model from the VA’s perspective for patients presenting for an index outpatient clinic visit with an ARI (Fig. 1). Effectiveness was measured as quality-adjusted life-years (QALYs). Cost and utility parameters for antibiotic treatment, adverse drug reactions (ADRs), and healthcare utilization were obtained from the published literature. Probability parameters for antibiotic treatment, appropriateness of treatment, antibiotic ADRs, hospitalization, and return ARI visits were estimated using VA Corporate Data Warehouse data from a total of 22,137 patients in the 10 clinics during 2014–2019 before and after the intervention. Detailed cost data on the development of the AD and AF materials and electronically captured time and effort for the National AD Service activities by specific providers from a national ARI campaign were used as a proxy for the cost estimate of similar activities conducted in this intervention. We performed 1-way and probabilistic sensitivity analyses (PSAs) using 10,000 second-order Monte Carlo simulations on costs and utility values using their means and standard deviations. Results: The proportion of uncomplicated ARI visits with antibiotics prescribed (59% vs 40%) was lower and appropriate treatment was higher (24% vs 32%) after the intervention. The intervention was estimated to cost $110,846 (2018 USD) over a 2-year period. Compared to no intervention, the intervention had lower mean costs ($880 vs $517) and higher mean QALYs (0.837 vs 0.863) per patient because of reduced inappropriate treatment, ADRs, and subsequent healthcare utilization, including hospitalization. In threshold analyses, the antibiotic stewardship strategy was no longer dominant if intervention cost was >$64,415,000 or the number of patients cared for was <3,672. In the PSA, the antibiotic stewardship intervention was dominant in 100% of the 10,000 Monte Carlo iterations (Fig. 2). Conclusions: In every scenario, the VA outpatient AD and AF antibiotic stewardship intervention was a dominant strategy compared to no intervention.Funding: NoneDisclosures: None

scholarly journals A Tool for Promoting Responsible Antibiotic Prescribing across Settings and Sectors

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Anette Hulth ◽  
Sonja Lofmark ◽  
Jeff Andre ◽  
Rachel Chorney ◽  
Emily Cohn ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Resistance ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Web Based ◽  
Antimicrobial Prescribing ◽  
Cochrane Database ◽  
Resistance Data

ObjectiveTo develop, evaluate, and implement a universal online platform - termed OPEN Stewardship - to promote responsible antimicrobial prescribing (antimicrobial stewardship).IntroductionAntibiotic resistance is a mounting public health threat calling for action on global, national and local levels. Antibiotic use has been a major driver of increasing rates of antibiotic resistance. This has given rise to the practice of antibiotic stewardship, which seeks to reduce unnecessary antibiotic use across different care settings. Antibiotic stewardship has been increasingly applied in hospital settings, but adoption has been slow in many ambulatory care settings including primary care of humans. Uptake of antibiotic stewardship in veterinary care has been similarly limited. Audit and feedback systems of antibiotic use coupled with patterns of antibiotic use and best practice guidelines have proven useful in outpatient settings, but scale-up is limited by heterogeneous systems of care and limited resources.MethodsA multi-sectoral team with partners from Canada, Israel and Sweden is developing a web-based platform for administering antibiotic stewardship across multiple care settings and sectors, for human and animal prescribers. There are several interventions which support behaviour change and can be applied to antibiotic stewardship programs. Systematic reviews have found beneficial effects of numerous behaviour change interventions for optimizing clinical practice such as computerized reminders [1], opinion leaders as champions for change [2], and audit and feedback [3]. A recent Cochrane review [4] found that interventions to enable correct use of antibiotics improved policy compliance, and that enabling interventions that included feedback were more likely to be effective. We will use antibiotic prescribing benchmarking, focused guidelines, and local patterns of antibiotic resistance as key components that can be deployed as feedback through this antibiotic stewardship platform.The OPEN Stewardship platform will be hosted on an AWS cloud-based server using industry standard encryption. The platform will function with a central administrator who will enroll and deliver feedback to participating prescribers. This platform will be evaluated prospectively in two countries (Canada and Israel) to evaluate user experience of the feedback as well as impact on antimicrobial prescribing. The evaluation will include prescribers from both human and animal health. After the prospective evaluation, the platform will be made available online for broad multi-sectoral use.ResultsWe have designed the interface for a web-based platform for antibiotic stewardship which will be used in a multinational prospective primary care stewardship intervention in 2019 and 2020 and subsequently rolled out for broad public use (www.openasp.org). The platform layout can be seen in Figure 1. Data capture for aggregate prescriber level antibiotic use and local guidelines will be possible through both a manual graphical user interface and a dataset template upload. Antibiotic resistance data will be pulled from a companion database (www.resistanceopen.org). Administrators will be able to generate unique feedback forms containing visualizations and snapshots from antibiotic use, guidelines, and antibiotic resistance data (Figure 2). These can then be delivered by email on an individual or scheduled basis for one or multiple prescribers simultaneously. Participating prescribers will also have the option to login to view their own profile and browse antibiotic use, resistance and guidelines.ConclusionsAntibiotic stewardship needs to be adopted in a fashion that is country and context specific and not administered from the top down. With our approach we seek to empower groups from any country or care setting to provide regional and tailored stewardship feedback through an open interface. We have here demonstrated the design of an web-based antibiotic stewardship platform which will be evaluated prospectively and subsequently made available for open and broad multi-sectoral use - in keeping with a One Health approach.References1. Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD001096.2. Flodgren G, Eccles MP, Shepperd S, Scott A, Parmelli E, Beyer FR. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009255.3. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259.4. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD003543. 

scholarly journals Tackling AMR crisis in India: Changing paradigm

2020 ◽  
Vol 11 (6) ◽  
pp. 129-137
Author(s):  
Sandeep Lahiry ◽  
Rajesh Ramalingam ◽  
Krunal Dalal ◽  
Ashwini Pawar ◽  
Yashpal Chugh ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Positive Impact ◽  
Action Plan ◽  
National Policy ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Audit And Feedback ◽  
Research Network ◽  
Health Concern ◽  
Infection Control Guidelines

Antimicrobial resistance (AMR) is an important public health concern globally. For India, undoubtedly, AMR has had profound impact on its health & socioeconomic parameters. Several hospital and community-based surveys have indicated alarming rise in incidence of multidrug resistant microbes, especially ‘superbugs’, having direct links with antibiotic use/misuse. Additionally, paucity in data with regards to quantification of AMR crisis & its determinants has been concerning. However, the national commitment to address AMR has steadily increased of late, with an oft-restated realization – it is time to act. Recent initiatives like National Policy for Containment of AMR (2011), Chennai Declaration (2012), Anti-microbial Resistance Surveillance and Research Network (2013), The Red Line Campaign (2016), National Action Plan (NAP) for AMR (2017), ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) are promising measures expected to have positive impact on both clinical and economic outcome in India. This paper provides a snapshot of major strategies proposed in recent years, including educational and awareness initiatives, infection control guidelines, audit and feedback, antimicrobial stewardship, surveillance projects etc. It also identifies technical challenges & opportunities for improved AMR mitigation in India.

scholarly journals 48. Local Implementation of an Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria Through Centralized Facilitation Required Minimal Costs and Effort

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Suja S Rajan ◽  
Larissa Grigoryan ◽  
John Van ◽  
Paola Lichtenberger ◽  
Payal K Patel ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Scale Up ◽  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Successful Implementation ◽  
Full Time ◽  
Research Coordinator ◽  
Intervention Cost ◽  
Project Coordination

Abstract Background The cost of an antibiotic stewardship intervention is an important yet often neglected factor in antibiotic stewardship research. We studied the costs associated with successful implementation of the “Kicking CAUTI” intervention to decrease treatment of asymptomatic bacteriuria (ASB). Methods A central coordinating site facilitated roll-out of an audit and feedback intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB in four Veterans Affairs medical centers. Each site had a physician site champion, a part-time research coordinator, and 1-2 additional participants (often pharmacists). Participants kept weekly time-logs to collect the minutes associated with intervention tasks, and percent full-time effort (FTE) and costs were computed. For weeks with missing logs the average minutes for each activity associated with each type of professional was imputed. Salary information was obtained from the Bureau of Labor Statistics and Association of American Medical Colleges. Results Research coordinator time comprised of majority of the personnel time, followed by the physician site champions (Figure 1). Each intervention site required about 10% FTE/year of a research coordinator, and 3.5% FTE/year and 3.8% FTE/year of a physician and pharmacist respectively. The coordinating site required 37% FTE/year of a research coordinator, and 9% FTE of a physician to spearhead the intervention. Research coordinators predominantly spent their time on chart-reviews and project coordination. Physician champions predominantly spent their time on delivering audit and feedback and project coordination. The intervention cost USD 22,299/year per site on average, and USD 45,359/year for the coordinating site. Conclusion The Kicking CAUTI intervention was successful at reducing urine cultures and associated antibiotic use, with minimal time from the local team members. The research coordinators’ time was primarily spent on collection of research data, which will not be necessary outside of a research project. Our model of centralized facilitation makes economic sense for widespread scale-up and dissemination of antibiotic stewardship interventions in integrated healthcare systems. Disclosures Barbara Trautner, MD, PhD, Genentech (Consultant, Scientific Research Study Investigator)

scholarly journals 178. Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes – National Healthcare Safety Network (NHSN), 2016–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Katryna A Gouin ◽  
Sarah Kabbani; Angela Anttila ◽  
Josephine Mak ◽  
Elisabeth Mungai ◽  
Ti Tanissha McCray ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Care Facility ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Long Term Care Facility ◽  
The Core ◽  
Use Of Resources ◽  
Core Elements

Abstract Background Since 2016, nursing homes (NHs) enrolled in the Centers for Disease Control and Prevention’s NHSN Long-term Care Facility (LTCF) Component have reported on their implementation of the core elements of antibiotic stewardship. In 2016, 42% of NHs reported implementing all seven core elements. Recent regulations require antibiotic stewardship programs in NHs. The objectives of this analysis were to track national progress in implementation of the core elements and evaluate how time dedicated to infection prevention and control (IPC) is associated with the implementation of the core elements. Methods We used the NHSN LTCF 2016–2018 Annual Surveys to assess NH characteristics and implementation of the core elements, defined as self-reported implementation of at least one corresponding stewardship activity. We reported absolute differences in percent implementation. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all seven core elements, while controlling for confounding by facility characteristics. Results We included 7,506 surveys from 2016–2018. In 2018, 71% of NHs reported implementation of all seven core elements, a 28% increase from 2016 (Fig. 1). The greatest increases in implementation from 2016–2018 were in Education (+19%), Reporting (+18%) and Drug Expertise (+15%) (Fig. 2). Ninety-eight percent of NHs had an individual responsible for antibiotic stewardship activities (Accountability), with 30% indicating that the role was fulfilled by an infection preventionist. Furthermore, 71% of NHs reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. NHs that reported at least 20 hours of IPC activity per week were 14% more likely to implement all seven core elements, when controlling for facility ownership and affiliation, 95% CI: (1.07, 1.20). Conclusion NHs reported substantial progress in antibiotic stewardship implementation from 2016–2018. Improvements in accessing drug expertise, providing education and reporting antibiotic use may reflect increased stewardship awareness and use of resources among NH providers under new regulatory requirements. NHs with at least 20 hours dedicated to IPC per week may have greater capacity to implement all core elements. Disclosures All Authors: No reported disclosures

scholarly journals Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bongyoung Kim ◽  
◽  
Myung Jin Lee ◽  
Se Yoon Park ◽  
Song Mi Moon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Quality Indicators ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Republic Of Korea ◽  
Cochrane Library ◽  
Surgical Prophylaxis ◽  
Modified Delphi ◽  
Stewardship Program ◽  
The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

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