Abstract
BackgroundOutcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate. Several studies have shown that adherence to guidelines dictating appropriate antimicrobial use positively influences clinical outcome, shortens length of hospital stay and contributes to the containment of antibiotic resistance.Quality indicators (QIs) can be systematically developed from these guidelines to define and measure appropriate antimicrobial use. We describe the development of a concise set of QIs to assess the appropriateness of antimicrobial use in adult patients with sepsis on a general medical ward or Intensive Care Unit (ICU).MethodsA RAND-modified, five step Delphi procedure was used. A multidisciplinary panel of 14 experts appraised and prioritized 40 key recommendations from within the Dutch national guideline on antimicrobial use for adult hospitalized patients with sepsis (http://www.swab.nl/guidelines). A procedure to select QIs relevant to clinical outcome, antimicrobial resistance and costs was performed using two rounds of questionnaires with a face-to-face consensus meeting between the rounds over a period of three months.ResultsThe procedure resulted in the selection of a final set of five QIs, namely: obtain cultures; prescribe empirical antimicrobial therapy according to the national guideline; start intravenous drug therapy; start antimicrobial treatment within one hour; and streamline antimicrobial therapy.ConclusionThis systematic, stepwise method, which combined evidence and expert opinion, led to a concise and therefore feasible set of QIs for optimal antimicrobial use in hospitalized adult patients with sepsis. The next step will entail subjecting these quality indicators to an applicability test for their clinimetric properties and ultimately, using these QIs in quality-improvement projects. This information is crucial for antimicrobial stewardship teams to help set priorities and to focus improvement.
Highlights
Outcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate
Despite the availability of these guidelines, antimicrobials are used inappropriately: several studies show that inappropriate initial antimicrobial use in patients with severe sepsis or septic van den Bosch et al BMC Infectious Diseases 2014, 14:345 http://www.biomedcentral.com/1471-2334/14/345 shock is associated with a reduction in survival [6,7,8,9]
For each number-one ranking by a panel member, we granted a potential Quality indicators (QIs) five points, for each number-two ranking, we granted four points and so on
Summary
Outcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate. We describe the development of a concise set of QIs to assess the appropriateness of antimicrobial use in adult patients with sepsis on a general medical ward or Intensive Care Unit (ICU). Studies point out that the majority (50 – 68%) of patients with severe sepsis are admitted to a general medical ward [3], with a. As the necessary first step in the improvement of appropriate use in patients with sepsis, guidelines have been developed that describe appropriate antimicrobial use in patients with sepsis admitted to a general medical ward or an Intensive Care Unit (ICU). The aim of our study was to develop a concise and feasible set of QIs to measure and monitor the appropriateness of antimicrobial use in adults with sepsis admitted to a general medical ward and/or ICU
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