S Reisfeld1, M Assaly2, E Tannous3, K Amarney3, M Stein4. 1. Infectious Diseases Unit, Hillel Yaffe Medical Centre, Hadera, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. Electronic address: sharonreisf@gmail.com. 2. Internal Medicine Department C, Hillel Yaffe Medical Centre, Hadera, Israel. 3. Pharmacy, Hillel Yaffe Medical Centre, Hadera, Israel. 4. Infectious Diseases Unit, Hillel Yaffe Medical Centre, Hadera, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Abstract
BACKGROUND: Approximately 20-50% of antimicrobial therapy in hospitalized patients is considered inappropriate, which may be associated with increased morbidity and mortality. The best method for evaluation of appropriateness is not well defined. AIM: To evaluate the rate of appropriate antimicrobial therapy in a secondary hospital using three different methods, and determine the rate of agreement between the different methods. METHODS: A point prevalence study included all adult hospitalized patients receiving systemic antimicrobial therapy during 2016, screened on a single day. Clinical, laboratory and therapeutic data were collected from patient files, and appropriateness was rated with a qualitative evaluation by expert opinion. In addition, a quantitative evaluation was performed according to 11 quality indicators (QIs) rated for each patient. A strict definition of appropriateness was fulfilled if six essential QIs were met, and a lenient definition was fulfilled if at least five QIs were met. Agreement between methods was analysed using kappa statistic. FINDINGS: Among 106 patients included, rates of appropriateness of antimicrobial therapy ranged from 20% to 75%, depending on the method of evaluation. Very low agreement was found between the strict definition and expert opinion (kappa=0.068), and medium agreement was found between the lenient definition and expert opinion (kappa=0.45). CONCLUSIONS: Rates of appropriateness of antimicrobial therapy varied between evaluation methods, with low to moderate agreement between the different methods.
BACKGROUND: Approximately 20-50% of antimicrobial therapy in hospitalized patients is considered inappropriate, which may be associated with increased morbidity and mortality. The best method for evaluation of appropriateness is not well defined. AIM: To evaluate the rate of appropriate antimicrobial therapy in a secondary hospital using three different methods, and determine the rate of agreement between the different methods. METHODS: A point prevalence study included all adult hospitalized patients receiving systemic antimicrobial therapy during 2016, screened on a single day. Clinical, laboratory and therapeutic data were collected from patient files, and appropriateness was rated with a qualitative evaluation by expert opinion. In addition, a quantitative evaluation was performed according to 11 quality indicators (QIs) rated for each patient. A strict definition of appropriateness was fulfilled if six essential QIs were met, and a lenient definition was fulfilled if at least five QIs were met. Agreement between methods was analysed using kappa statistic. FINDINGS: Among 106 patients included, rates of appropriateness of antimicrobial therapy ranged from 20% to 75%, depending on the method of evaluation. Very low agreement was found between the strict definition and expert opinion (kappa=0.068), and medium agreement was found between the lenient definition and expert opinion (kappa=0.45). CONCLUSIONS: Rates of appropriateness of antimicrobial therapy varied between evaluation methods, with low to moderate agreement between the different methods.
Authors: Jacqueline T Bork; Kimberly C Claeys; Emily L Heil; Mary Banoub; Surbhi Leekha; John D Sorkin; Michael Kleinberg Journal: Antimicrob Agents Chemother Date: 2020-07-22 Impact factor: 5.191