Metrics for quantifying antibiotic use in the hospital setting: results from a systematic review and international multidisciplinary consensus procedure

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Abstract

Background

Quantifying antibiotic use is an essential element of antibiotic stewardship since it allows comparison between different settings and time windows, and measurement of the impact of interventions. However, quantity metrics (QMs) and methods have not been standardized.

Objectives

To propose a set of QMs for antibiotic use in inpatients (IQMs) that are accepted globally by professionals in a range of disciplines. The study was conducted within the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project.

Methods

A systematic literature review using MEDLINE identified articles on measuring inpatient antibiotic use, published up to 29 January 2015. A consensually selected list of national and international web sites was screened for additional IQMs. IQMs were classified according to the type of numerator used and presented to a multidisciplinary panel of stakeholders. A RAND-modified Delphi consensus procedure, which consisted of two online questionnaires and a face-to-face meeting, was performed.

Results

The systematic literature review and web site search identified 168 eligible articles from which an initial list of 20 IQMs, composed of 20 different numerators and associated denominators was developed. The consensus procedure resulted in a final set of 12 IQMs. Among this final set, DDDs per 100(0) patient-days and days of therapy per patient-days were most frequently found in the review. The panel recommended that antibiotic use should be expressed in at least two metrics simultaneously.

Conclusions

Our consensus procedure identified a set of IQMs that we propose as an evidence-based global standard.

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Most cited references 34

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Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

Timothy H Dellit, Robert Owens, John E. McGowan … (2007)

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Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response.

Young Ik Cho, Timothy P Johnson, Jonathan B Vangeest (2013)

Surveys involving health care providers are characterized by low and declining response rates (RRs), and researchers have utilized various strategies to increase survey RRs among health professionals. Based on 48 studies with 156 subgroups of within-study conditions, a multilevel meta-regression analysis was conducted to summarize the effects of different strategies employed in surveys of health professionals. An estimated overall survey RR among health professionals was 0.53 with a significant downward trend during the last half century. Of the variables that were examined, mode of data collection, incentives, and number of follow-up attempts were all found to be significantly related to RR. The mail survey mode was more effective in improving RR, compared to the online or web survey mode. Relative to the non-incentive subgroups, subgroups receiving monetary incentives were more likely to respond, while nonmonetary incentive groups were not significantly different from non-incentive groups. When number of follow-ups was considered, the one or two attempts of follow-up were found to be effective in increasing survey RR among health professionals. Having noted challenges associated with surveying health professionals, researchers must make every effort to improve access to their target population by implementing appropriate incentive- and design-based strategies demonstrated to improve participation rates.

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Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy.

Ronald E Polk, Christina Fox, Anne Mahoney … (2007)

Hospitals are advised to measure antibiotic use and monitor its relationship to resistance. The World Health Organization's recommended metric is the defined daily dose (DDD). An alternative measure is the number of days of therapy (DOT). The purpose of this study was to contrast these measures. We measured the use of 50 antibacterial drugs that were administered to adults who were discharged from 130 US hospitals during 1 August 2002-31 July 2003. Of 1,795,504 patients, 1,074,174 received at least 1 dose of an antibacterial drug (59.8%). The mean (+/- standard deviation) of total antibacterial drug use measured by the number of DDDs per 1000 patient-days and the number of DOTs per 1000 patient-days were not significantly different (792+/-147 and 776+/-120, respectively; P=.137), although the correlation was poor (r=0.603). For some individual drugs, such as levofloxacin and linezolid, there was no significant difference between DDDs per 1000 patient-days and DOTs per 1000 patient-days, because the administered daily dosage was nearly equivalent to the DDD. When the administered dosage exceeded the DDD, such as for ampicillin-sulbactam and cefepime, estimates of use based on DDDs per 1000 patient-days significantly exceeded those based on DOTs per 1000 patient-days (P<.001). When the administered dosage was less than the DDD, such as for piperacillin-tazobactam and ceftriaxone, estimates of use based on DDDs per 1000 patient-days were significantly lower than those based on DOTs per 1000 patient-days (P<.001). The measurement of aggregate hospital antibiotic use by DDDs per 1000 patient-days and DOTs per 1000 patient-days is discordant for many frequently used antibacterial drugs, because the administered dose is dissimilar from the DDD recommended by the World Health Organization. DDD methods are useful for benchmarking purposes but cannot be used to make inferences about the number of DOTs or relative use for many antibacterial drugs.

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Author and article information

Journal

Journal ID (nlm-ta): J Antimicrob Chemother

Journal ID (iso-abbrev): J. Antimicrob. Chemother

Journal ID (publisher-id): jac

Title: Journal of Antimicrobial Chemotherapy

Publisher: Oxford University Press

ISSN (Print): 0305-7453

ISSN (Electronic): 1460-2091

Publication date (Print): June 2018

Publication date (Electronic): 06 June 2018

Publication date PMC-release: 06 June 2018

Volume: 73

Issue: Suppl 6 , Driving re-investment in Research and Development and responsible antibiotic use (DRIVE-AB): defi nitions, metrics and indicators

Pages: vi50-vi58

Affiliations

[1 ]Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia

[2 ]University of Rijeka Medical Faculty, Rijeka, Croatia

[3 ]Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

[4 ]Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands

[5 ]Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium

[6 ]University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium

[7 ]University of Antwerp, Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Antwerp, Belgium

[8 ]Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

[9 ]Université de Lorraine, APEMAC, F-54000 Nancy, France

[10 ]Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

[11 ]Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France

Author notes

Corresponding author. Department of Clinical Pharmacology, University Hospital Rijeka, University of Rijeka Medical Faculty, Rijeka, Croatia. Tel: +385992367664; E-mail: mirji.stanic@ 123456gmail.com 0000-0002-4123-9937

Members are listed in the Acknowledgements section.

Author information

Mirjana Stanić Benić http://orcid.org/0000-0002-4123-9937

Annelie A Monnier http://orcid.org/0000-0002-5844-286X

Benedikt Huttner http://orcid.org/0000-0002-1749-9464

Article

Publisher ID: dky118

DOI: 10.1093/jac/dky118

PMC ID: 5989607

PubMed ID: 29878222

SO-VID: 3b723346-df66-4e21-8720-01d569565368

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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Metrics for quantifying antibiotic use in the hospital setting: results from a systematic review and international multidisciplinary consensus procedure

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Abstract

Background

Objectives

Methods

Results

Conclusions

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Karger: Oncology

Most cited references 34

Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response.

Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy.

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