Measuring Appropriate Antimicrobial Use: Attempts at Opening the Black Box

Abstract

Indiscriminate antimicrobial use has plagued medicine since antibiotics were first introduced into clinical practice >70 years ago. Infectious diseases physicians and public health officials have advocated for preservation of these life-saving drugs for many years. With rising burden of antimicrobial-resistant organisms and Clostridium difficile infections, halting unnecessary antimicrobial use has become one of the largest public health concerns of our time. Inappropriate antimicrobial use has been quantified in various settings using numerous definitions; however, no established reference standard exists. With mounting national efforts to improve antimicrobial use, a consensus definition and standard method of measuring appropriate antimicrobial use is imperative. We review existing literature on systematic approaches to define and measure appropriate antimicrobial use, and describe a collaborative effort at developing standardized audit tools for assessing the quality of antimicrobial prescribing.

Identifying antibiotic stewardship interventions to meet the NHS England CQUIN: an evaluation of antibiotic ­prescribing against published evidence-based antibiotic audit tools

“…The use of audit tools such as those developed by Spivak et al 13 have enabled us to identify stewardship practices amenable to change that would likely impact on patient care and the wider antibiotic resistance agenda.…”

“…The antibiotic management was reviewed against three of four audit tools. 13 'Assessment of appropriateness of antibiotic use for resistant Gram-positive infections' tool was excluded due to the low prevalence of vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus in the study hospital.…”

“…We made the following amendments to the review tools. 13 To the CAP tool we included a CURB 65 score ≥3 to reflect UK practice. 17 CURB 65 estimates CAP mortality, patients scoring one point for each of: confusion, urea >7 mmol/L, respiratory rate >30 bpm, systolic blood pressure below 100 mmHg and age over 65 years.…”

“…One group has developed evidenced-based audit tools enabling organisations to review appropriateness of antibiotic prescribing against a peer-reviewed standard. 13 This study sets out to review antibiotic prescribing in an English hospital against published evidence-based antibiotic stewardship audit tools. 13 Recommended changes to practice will be made to the Hospital Management Board with an emphasis on changes that will enable the hospital to meet the financially incentivised CQUIN antibiotic consumption reduction targets.…”

Survey of knowledge and perceptions of antibiotic resistance and antibiotic stewardship among doctors and pharmacists in a tertiary hospital: a pilot study

“…Infections caused by antibiotic resistant bacteria are di cult to treat and are associated with increased mortality and increased healthcare cost compared to infections caused by sensitive bacteria [1]. Unnecessary or inappropriate use of antibiotics, such as, antibiotics for nonbacterial infections (in uenza, most upper respiratory tract infections (e.g., common cold), yeast infection) or selecting suboptimal type of antibiotic causes the emergence of resistant bacteria [2][3][4][5]. The World Health Organization (WHO) surveillance report of resistance in bacteria (E. coli, K. pneumoniae, S. aureus) associated with hospital and community infections showed increased resistance to rst line agents [1].…”