Quality improvement program of adult urinary tract infection management: Review and impact

Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND - modified Delphi procedure

INTRODUCTION

Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use.

OBJECTIVES

The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals.

METHODS

A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium.

RESULTS

A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds.

CONCLUSION

Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.

Impact of amoxicillin and oral amoxicillin-clavulanic acid defined daily doses on consumption indicators

OBJECTIVE

To measure the impact of the differences between recommended daily average maintenance doses and defined daily doses on antimicrobial consumption indicators (amoxicillin+amoxicillin-clavulanic acid).

MATERIAL AND METHODS

We calculated the impact of the antibacterial agent switch or de-escalation and reviewed the consumption indicators of our French hospital with defined daily doses (DDD) of 3g. We also applied these DDDs to French and European community setting indicators in private practice.

RESULTS

We observed a modification in trend consumption indicators over a 10-year period: indicator stability for our hospital (-0.32% versus +5.45%), decrease for French community indicators (-9.9% versus +6.7%). The recalculated 2015 data for European community indicators showed France as the 9th largest European consumer (versus 4th position before).

CONCLUSION

DDDs must be modified to have appropriate indicators to evaluate antimicrobial stewardship programs and to penalize prescriptions favoring the emergence of resistant pathogens.

Use of antibiotics by adults: a population-based cross-sectional study

BACKGROUND

The consumption of antibiotics has been widely discussed, mainly because of antibacterial resistance, which has become a worldwide concern. In Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made under medical prescription. The aims of this study were to evaluate antibiotic use and associated factors among adults in the Metropolitan Region of Manaus, Amazonas, Brazil, and to assess the proportion of self-medication from this use.

DESIGN AND SETTING

Population-based cross-sectional study conducted in the Metropolitan Region of Manaus between May and August 2015.

METHODS

Adults aged ≥ 18 years were selected through probabilistic sampling in three stages. Trained interviewers collected data from the participants in their homes. Antibiotic consumption over the last 15 days was reported. Bivariate analysis was used to calculate the prevalence ratio (PR) of antibiotic usage, with 95% confidence interval (95% CI). A multivariate model adjusted according to significant variables at P ≤ 0.20 using Poisson regression with robust variance was constructed.

RESULTS

The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted analysis showed that consumption was higher among women than among men (PR 1.58; 95% CI 1.11-2.24) and among people with fair health status than among those with good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was 19.0%; amoxicillin was the most self-medicated antibiotic (10/26).

CONCLUSION

Antibiotic use was associated with women and individuals with fair health status. One fifth of the antibiotics were consumed through self-medication, contrary to the current Brazilian legislation.