Development of quality indicators for appropriate antibiotic use in daily hospital practice

Worldwide, antibiotic consumption and antibiotic resistance are still on the rise, which, together with the steady decline in the discovery of new antibiotics, creates one of the greatest current threats to human health. To help curbing antibiotic resistance in hospitals, better use of current agents is warranted and a decrease of inappropriate antibiotic use is imperative.
Quality indicators (QIs) are measurable elements of practice performance for which there is evidence or consensus that they can be used to assess and change the quality of antibiotic care provided. We developed a set of generic evidence-based QIs to measure appropriate antibiotic use in hospitalized adult patients with a suspected bacterial infection, using a RAND modified Delphi method. Hereafter we validated these generic QIs by performing a point prevalence measurement at 4 university and 18 non-university hospitals located throughout the Netherlands, including 1890 patients using antibiotics for a suspected bacterial infection.
This resulted in a reliable set of generic QIs which can be used to measure and improve the various steps in the process of antibiotic use in the hospital, by identifying for which step along the antibiotic pathway there is room for improvement. In particular adherence to a combination of generic process QIs, rather than just one QI, seems to decrease the duration of hospital stay. Prospective studies are needed to determine whether interventions that improve compliance with these validated generic QIs, could improve patient outcome and reduces length of stay.