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Table 1 Stewardship objectives reflecting processes and organization of care, and the corresponding quality indicators

From: Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry

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   
  1. aantibiotics on a list of “restricted” and “limited prescription” antimicrobial drugs
  2. The numerator and denominator described in the third and fourth column were used to calculate quality indicator performance. [9]