Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea.
Antimicrob Resist Infect Control. 2021 Mar 6;10(1):48. doi: 10.1186/s13756-021-00913-y.
An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea.
A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting.
The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1-6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected.
We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.
有效的抗生素管理计划依赖于适当的抗生素使用的衡量，而这方面缺乏共识。我们旨在为韩国制定一套全国范围内的重点监测的关键质量指标（QIs）。
对 PubMed、EMBASE 和 Cochrane Library 进行了系统的文献检索（截至 2019 年 11 月 20 日的出版物）。从检索中检索出潜在的关键 QIs，然后由一个多学科专家小组使用 RAND 改良 Delphi 程序进行评估，该程序包括两次在线调查和一次面对面会议。
从 21 项研究中确定了 23 个潜在的关键 QIs，并提交给 25 个多学科专家小组，其中 17 个关键 QIs 保留了高度的一致性（13 个住院患者 QIs，7 个门诊患者 QIs，3 个手术预防 QIs）。在加总重要性评分和适用性后，选择了 6 个关键 QIs [6 个住院患者 QIs（Q1-6）和 3 个门诊患者 QIs（Q1、2 和 5）]。（1）根据指南规定经验性使用抗生素治疗，（2）将经验性抗生素改为针对病原体的治疗，（3）从疑似感染部位获取培养样本，（4）获取两份血培养物，（5）根据肾功能调整抗生素剂量，（6）记录抗生素计划。在手术预防方面，选择了根据指南规定开抗生素和在切开前 1 小时开始抗生素治疗的 QIs。
我们确定了关键的 QIs 来衡量抗生素治疗的适当性，以确定需要改进的目标，并评估抗生素管理干预的效果。
