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Title: Development of quality indicators for antimicrobial treatment in adults with sepsis
Authors: van den Bosch, Caroline M. A.
Hulscher, Marlies E. J. L.
Natsch, Stephanie
Prins, Jan M.
Geerlings, Suzanne E.
Issue Date: 2014
Abstract: Background: Outcomes 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). Methods: A 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 ( 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. Results: The 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. Conclusion: This 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.
Notes: [van den Bosch, Caroline M. A.; Prins, Jan M.; Geerlings, Suzanne E.] Acad Med Ctr, Ctr Infect & Immun Amsterdam CINIMA, Dept Internal Med, Div Infect Dis, NL-1105 AZ Amsterdam, Netherlands. [Hulscher, Marlies E. J. L.] Radboud Univ Nijmegen, Med Ctr, Sci Inst Qual Healthcare IQ Healthcare, NL-6525 ED Nijmegen, Netherlands. [Natsch, Stephanie] Radboud Univ Nijmegen, Med Ctr, Dept Clin Pharm, NL-6525 ED Nijmegen, Netherlands. [Gyssens, Inge C.] Radboud Univ Nijmegen, Med Ctr, Dept Internal Med, NL-6525 ED Nijmegen, Netherlands. [Gyssens, Inge C.] Canisius Wilhelmina Ziekenhuis, Dept Med Microbiol & Infect Dis, Nijmegen, Netherlands. [Gyssens, Inge C.] Hasselt Univ, Hasselt, Belgium.
Keywords: Sepsis; Antimicrobial treatment; Quality indicator; Quality improvement; Appropriate antimicrobial use; Appropriate antibiotic use;sepsis; antimicrobial treatment; quality indicator; quality improvement; appropriate antimicrobial use; appropriate antibiotic use
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e-ISSN: 1471-2334
DOI: 10.1186/1471-2334-14-345
ISI #: 000338168000001
Rights: © 2014 van den Bosch et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Category: A1
Type: Journal Contribution
Validations: ecoom 2015
Appears in Collections:Research publications

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