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A Concise Set of Structure and Process Indicators to Assess and Compare Antimicrobial Stewardship Programs Among EU and US Hospitals: Results From a Multinational Expert Panel

Published online by Cambridge University Press:  15 July 2016

Lori A. Pollack ,
Diamantis Plachouras ,
Ronda Sinkowitz-Cochran ,
Heidi Gruhler ,
Dominique L. Monnet ,
J. Todd Weber  and
Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) Expert Panel on Stewardship Structure and Process Indicators
Lori A. Pollack*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Diamantis Plachouras
Affiliation:
European Centre for Disease Prevention and Control, Stockholm, Sweden.
Ronda Sinkowitz-Cochran
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Heidi Gruhler
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Dominique L. Monnet
Affiliation:
European Centre for Disease Prevention and Control, Stockholm, Sweden.
J. Todd Weber
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Lori A. Pollack, MD, MPH, 4770 Buford Hwy, NE, Mailstop F-76, Atlanta, GA 30341 (lpollack@cdc.gov).
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Abstract

OBJECTIVES

To develop common indicators, relevant to both EU member states and the United States, that characterize and allow for meaningful comparison of antimicrobial stewardship programs among different countries and healthcare systems.

DESIGN

Modified Delphi process.

PARTICIPANTS

A multinational panel of 20 experts in antimicrobial stewardship.

METHODS

Potential indicators were rated on the perceived feasibility to implement and measure each indicator and clinical importance for optimizing appropriate antimicrobial prescribing.

RESULTS

The outcome was a set of 33 indicators developed to characterize the infrastructure and activities of hospital antimicrobial stewardship programs. Among them 17 indicators were considered essential to characterize an antimicrobial stewardship program and therefore were included in a core set of indicators. The remaining 16 indicators were considered optional indicators and included in a supplemental set.

CONCLUSIONS

The integration of these indicators in public health surveillance and special studies will lead to a better understanding of best practices in antimicrobial stewardship. Additionally, future studies can explore the association of hospital antimicrobial stewardship programs to antimicrobial use and resistance.

Infect Control Hosp Epidemiol 2016:1–11

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 10 , October 2016 , pp. 1201 - 1211
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: The European Congress of Clinical Microbiology and Infectious Diseases meeting; April 2015; Copenhagen; and the International Conference on Prevention & Infection Control meeting; June 2015; Geneva; and posted as part of the Update Summary of TATFAR Recommendations on the CDC TATFAR website in July 2015.

Members of the TATFAR Expert Panel on Stewardship Structure and Process Indicators are listed at the end of the text.

References

REFERENCES

1. Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.Google Scholar
2. Feazel, LM, Malhotra, A, Perencevich, EN, Kaboli, P, Diekema, DJ, Schweizer, ML. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. J Antimicrob Chemother 2014;69:1748–1754.CrossRefGoogle ScholarPubMed
3. Kaki, R, Elligsen, M, Walker, S, Simor, A, Palmay, L, Daneman, N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:1223–1230.Google Scholar
4. ASHP statement on the pharmacist’s role in antimicrobial stewardship and infection prevention and control. Am J Health Syst Pharm 2010;67:575–577.Google Scholar
5. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.Google Scholar
6. Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194–200.Google Scholar
7. Ashiru-Oredope, D, Sharland, M, Charani, E, McNulty, C, Cooke, J. Improving the quality of antibiotic prescribing in the NHS by developing a new antimicrobial stewardship programme: Start Smart—Then Focus. J Antimicrob Chemother 2012;67:i51–i63.Google Scholar
8. Canton, R, Bryan, J. Global antimicrobial resistance: from surveillance to stewardship. Part 2: stewardship initiatives. Expert Rev Anti Infect Ther 2012;10:1375–1377.Google Scholar
9. Agarwal, R, Schwartz, DN. Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review. Clin Infect Dis 2011;53:379–387.Google Scholar
10. Huttner, A, Harbarth, S, Carlet, J, et al. Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control 2013;2:31.Google Scholar
11. Tacconelli, E, Cataldo, MA, Dancer, SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014;20:1–55.Google Scholar
12. Transatlantic Taskforce on Antimicrobial Resistance (TATFAR). About TATFAR. CDC website. http://www.cdc.gov/drugresistance/tatfar/about.html. Accessed July 2, 2015.Google Scholar
13. The White House. US-EU Joint Declaration and Annexes. White House website. https://www.whitehouse.gov/the-press-office/us-eu-joint-declaration-and-annexes. Published November 3, 2009. Accessed August 27, 2015.Google Scholar
14. Transatlantic Taskforce on Antimicrobial Resistance Recommendations. Recommendations for future collaboration between the US and EU. CDC website. http://www.cdc.gov/drugresistance/pdf/210911_tatfar_report_508.pdf. Published 2011. Accessed May 1, 2016.Google Scholar
15. Amadeo, B, Dumartin, C, Parneix, P, Fourrier-Reglat, A, Rogues, AM. Relationship between antibiotic consumption and antibiotic policy: an adjusted analysis in the French healthcare system. J Antimicrob Chemother 2011;66:434–442.Google Scholar
16. Buyle, FM, Metz-Gercek, S, Mechtler, R, et al. Development and validation of potential structure indicators for evaluating antimicrobial stewardship programmes in European hospitals. Eur J Clin Microbiol Infect Dis 2013;32:1161–1170.Google Scholar
17. Cooke, J, Alexander, K, Charani, E, et al. Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother 2010;65:2669–2673.Google Scholar
18. Morris, AM, Brener, S, Dresser, L, et al. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2012;33:500–506.Google Scholar
19. Abbo, L, Lo, K, Sinkowitz-Cochran, R, et al. Antimicrobial stewardship programs in Florida’s acute care facilities. Infect Control Hosp Epidemiol 2013;34:634–637.Google Scholar
20. Doron, S, Nadkarni, L, Lyn Price, L, et al. A nationwide survey of antimicrobial stewardship practices. Clin Ther 2013;35:758–765.Google Scholar
21. Trivedi, KK, Rosenberg, J. The state of antimicrobial stewardship programs in California. Infect Control Hosp Epidemiol 2013;34:379–384.Google Scholar
22. Fitch, K, Bernstein, SJ, Agular, MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica: RAND; 2001.Google Scholar
23. van Duijn, PJ, Bonten, MJ. Antibiotic rotation strategies to reduce antimicrobial resistance in gram-negative bacteria in European intensive care units: study protocol for a cluster-randomized crossover controlled trial. Trials 2014;15:277.Google Scholar
24. Martinez, JA, Nicolas, JM, Marco, F, et al. Comparison of antimicrobial cycling and mixing strategies in two medical intensive care units. Crit Care Med 2006;34:329–336.Google Scholar
25. Bratzler, DW, Hunt, DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006;43:322–330.Google Scholar
26. Fry, DE. Surgical site infections and the Surgical Care Improvement Project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008;9:579–584.Google Scholar
27. Zarb, P, Coignard, B, Griskeviciene, J, et al. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 2012;17:pii: 20316.Google Scholar
28. Kurz, X, Mertens, R, Ronveaux, O. Antimicrobial prophylaxis in surgery in Belgian hospitals: room for improvement. Eur J Surg 1996;162:15–21.Google Scholar
29. Buyle, FM, Metz-Gercek, S, Mechtler, R, et al. Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics. J Antimicrob Chemother 2012;67:2043–2046.Google Scholar
30. Thern, J, de With, K, Strauss, R, Steib-Bauert, M, Weber, N, Kern, WV. Selection of hospital antimicrobial prescribing quality indicators: a consensus among German antibiotic stewardship (ABS) networkers. Infection 2014;42:351–362.Google Scholar
31. Centers for Disease Control and Prevention. National Healthcare Safety Network. Patient safety component—annual hospital survey. CDC website. http://www.cdc.gov/nhsn/forms/57.103_PSHospSurv_BLANK.pdf. Published 2014. Accessed May 14, 2015.Google Scholar
32. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. CDC website. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Published 2014. Accessed March 25, 2014.Google Scholar
33. van den Bosch, CM, Geerlings, SE, Natsch, S, Prins, JM, Hulscher, ME. Quality indicators to measure appropriate antibiotic use in hospitalized adults. Clin Infect Dis 2015;60:281–291.Google Scholar
34. Schulz, LT, Fox, BC, Polk, RE. Can the antibiogram be used to assess microbiologic outcomes after antimicrobial stewardship interventions? A critical review of the literature. Pharmacotherapy 2012;32:668–676.Google Scholar
35. Transatlantic Taskforce on Antimicrobial Resistance. Recommendations for future collaboration between the US and EU: progress report. CDC website. http://www.cdc.gov/drugresistance/tatfar/report.html. Published 2014. Accessed May 1, 2016.Google Scholar
36. Jackson, N, Waters, E. Criteria for the systematic review of health promotion and public health interventions. Health Promot Int 2005;20:367–374.Google Scholar