Table 1 Stewardship objectives reflecting processes and organization of care, and the corresponding quality indicators
Number | Stewardship objective, process of care recommendation | Corresponding quality indicator | |
|---|---|---|---|
Numerator description | Denominator description | ||
1 | Take 2 sets of blood cultures before starting antibiotic therapy | Number of patients in whom at least 2 sets of blood cultures were taken before systemic antibiotic therapy was started | Total number of patients who started with empirical systemic antibiotic therapy |
2 | Take cultures from suspected sites of infection | Number of patients in whom cultures from suspected sites of infections were taken within 24 h after the systemic antibiotics were started | Total number of patients who started with systemic antibiotic therapy |
3 | Prescribe empirical antibiotic therapy according to local guidelinea | Number of patients who started with empirical systemic antibiotic therapy according to the national guideline | Total number of patients who started with empirical systemic antibiotic therapy |
4 | Adapt antibiotic dosage to renal function | Number of patients with a compromised renal function with a dosing regimen adjusted to renal function | Total number of patients who started with systemic antibiotic therapy which should be dosed according to renal function, and who had an unknown or compromised renal function. |
5 | Document antibiotic plan | Number of patients for whom an antibiotic plan was documented in the case notes | Total number of patients who started with systemic antibiotic therapy |
6 | Change empirical to pathogen-directed therapy | Number of patients with empirical therapy whose culture became positive and changing to pathogen-directed therapy was done correctly. | Total number of patients with empirical systemic antibiotics, whose culture became positive |
7 | Switch from intravenous to oral therapy on the basis of the clinical condition and when oral treatment is adequate | Number of patients with intravenous antibiotics for 48-72 h, in whom changing to oral antibiotic therapy on the basis of clinical conditions was done. | Total number of patients with intravenous antibiotics for 48-72 h, in whom changing to oral antibiotic therapy on the basis of the clinical condition was indicated |
8 | Perform therapeutic drug monitoring when the therapy is >3 days for aminoglycosides and >5 days for vancomycin | Number of patients on aminoglycosides or vancomycine in whom a serum drug level has been determined after respectively >3 or >5 days of therapy | Total number of patients who received aminoglycosides for >3 days and/or vancomycin for >5 days |
9 | Discontinue antibiotic therapy if infection is not confirmed | Number of patients whose empirical antibiotic therapy was discontinued within 7 days based on the lack of clinical and/or microbiological evidence of infection. | Total number of patients who started empirical systemic antibiotic therapy, but lacked clinical and/or microbiological evidence of infection. |
10 | Perform ID specialist bedside consultations in hospitalized patients with a Staphylococcus aureus bacteremia | Number of patients with Staphylococcus aureus bacteremia who had a bedside consultation of an ID specialist | Total number of patient with a Staphylococcus aureus bacteremia |
11 | Assess patients’ adherence | Number of patients adherent to the prescription’s instructions | Total number of patients with a prescription of antibiotics |
Stewardship objective, organization of care recommendation | |||
12 | A local antibiotic guideline should be present and an update should be done every 3 years | ||
13 | The local guidelines should correspond to the national antibiotic guidelines but deviate based on local resistance patterns | ||
14 | A list of restricted antibiotics should be present | ||