Minchella A, Lechiche C, Poujol H, Molinari N, Sotto A
Service des maladies infectieuses et tropicales, CHU de Nîmes, place du Pr-Robert-Debré, Nîmes cedex, France.
Med Mal Infect. 2010 Feb;40(2):100-5. doi: 10.1016/j.medmal.2009.08.017. Epub 2009 Sep 30.
Methods used for the assessment of professional practices must be dependable and reproducible. The aim of this study was to assess a method used in our hospital to assess antibiotic therapy for acute community-acquired pneumonia (CAP).
In this study, a pharmacist and two infectious disease specialists retrospectively and independently evaluated the compliance to local antibiotic guidelines for 124 patients. The assessment tool was a Medical Appropriateness Index (MAI) (nine items). The kappa agreement index (K) among experts was calculated.
The agreement among experts was poor for the initial antibiotic treatment (K=0.16) and route of administration (K=0.14), low for the duration of treatment (K=0.34), and null for the dose and adjustment to 72 hours.
Differences between experts can be explained by the complexity of medical records, the number of items assessed, the complexity of the MAI, but also by the specialization and experience of experts. Thus, the assessment of CAP antibiotic therapy requires the use of appropriate methods targeting reliable criteria.
