Assessing appropriateness of antimicrobial therapy: in the eye of the interpreter.

Autor:	DePestel DD; Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts., Eiland EH 3rd; Department of Pharmacy, Huntsville Hospital, Alabama., Lusardi K; Department of Pharmacy, University of Arkansas for Medical Sciences Medical Center, Little Rock., Destache CJ; Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska., Mercier RC; College of Pharmacy, University of New Mexico, Albuquerque., McDaneld PM; Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester/Manchester., Lamp KC; Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts., Chung TJ; Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts., Hermsen ED; Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2014 Oct 15; Vol. 59 Suppl 3, pp. S154-61.
DOI:	10.1093/cid/ciu548
Abstrakt:	To address the increase of drug-resistant bacteria and widespread inappropriate use of antimicrobials, many healthcare institutions have implemented antimicrobial stewardship programs to promote appropriate use of antimicrobials and optimize patient outcomes. However, a consensus definition of appropriate use is lacking. We conducted a multicenter observational study to compare 4 definitions of appropriateness--a study site-specific definition, use supported by susceptibility data, use supported by electronic drug information resources (Clinical Pharmacology/Micromedex), or study site principal investigator (PI) opinion-among patients receiving 1 or more of 13 identified antimicrobials. Data were collected for 262 patients. Overall, appropriateness with the 4 definitions ranged from 79% based on PI opinion to 94% based on susceptibility data. No single definition resulted in consistently high appropriate use for all target antimicrobials. For individual antimicrobials, the definitions with the highest rate of appropriate use were Clinical Pharmacology/Micromedex support (6 of 7 antimicrobials) and susceptibility data (5 of 7 antimicrobials). For specific indications, support from susceptibility data resulted in the highest rate of appropriate use (4 of 7 indications). Overall comparisons showed that appropriateness assessed by PI opinion differed significantly compared with other definitions when stratified by either target antimicrobial or indication. The significant variability in the rate of appropriate use highlights the difficulty in developing a standardized definition that can be used to benchmark judicious antimicrobial use. (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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