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1 March 2008

Volume 46, Number 5
Clinical Infectious Diseases 2008;46:703–711
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4605-0010$15.00
DOI: 10.1086/527384
MAJOR ARTICLE

Development of Quality Indicators for the Antibiotic Treatment of Complicated Urinary Tract Infections: A First Step to Measure and Improve Care

H. S. Hermanides,1

M. E. J. L. Hulscher,2

J. A. Schouten,2

J. M. Prins,1 and

S. E. Geerlings1

1Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine & AIDS, Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, and 2Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

Background.Appropriateness of antibiotic treatment of urinary tract infection (UTI) is important. The aim of this study was to develop a set of valid, reliable, and applicable indicators to assess the quality of antibiotic use in the treatment of hospitalized patients with complicated UTI.

Methods.A multidisciplinary panel of 13 experts reviewed and prioritized recommendations extracted from a recently developed evidence‐based national guideline for the treatment of complicated UTI. The content validity was assessed in 2 consecutive rounds with an in‐between discussion meeting. Next, we tested the feasibility, interobserver reliability, opportunity for improvement, and case‐mix stability of the potential indicators for a data set of 341 inpatients and outpatients with complicated UTIs who were treated at the urology or internal medicine departments at 4 hospitals.

Results.The panel selected and prioritized 13 indicators. Four and 9 indicators were performed satisfactorily in the urology and internal medicine departments, as follows: performance of urine culture, prescription of treatment in accordance with guidelines, tailoring of treatment on the basis of culture results, and a switch to oral treatment when possible in the urology and internal medicine departments; and selective use of fluoroquinolones, administration of treatment for at least 10 days, prescription of treatment for men in accordance with guidelines, replacement of catheters in patients with UTI, and adaptation of the dosage on the basis of renal function in the internal medicine department.

Conclusion.A systemic evidence‐ and consensus‐based approach was used to develop a set of valid quality indicators. Tests of the applicability of these indicators in practice in different settings is essential before they are used in quality‐improvement strategies.

Received 2 July 2007; accepted 13 October 2007; electronically published 29 January 2008.

Reprints or correspondence: Suzanne Geerlings, Academic Medical Center, Rm. F4–217, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ().

Cited by

Patricia Pavese, MD; Nathalie Saurel, PharmD; José Labarère, MD; Corinne Decouchon, MD; Jean‐Philippe Vittoz, BSc; Luc Foroni, PharmD; Max Maurin, MD, PhD; Patrice François, MD, PhD. (2009) Does an Educational Session With an Infectious Diseases Physician Reduce the Use of Inappropriate Antibiotic Therapy for Inpatients With Positive Urine Culture Results? A Controlled Before‐and‐After Study •. Infection Control and Hospital Epidemiology 30:6, 596-599
Online publication date: 1-Jun-2009.
Abstract-Full Text-PDF Version (130 kB)
Tejal Gandhi, MD; Scott A. Flanders, MD; Erica Markovitz, MD; Sanjay Saint, MD, MPH; Daniel R. Kaul, MD. (2009) Importance of Urinary Tract Infection to Antibiotic Use Among Hospitalized Patients •. Infection Control and Hospital Epidemiology 30:2, 193-195
Online publication date: 1-Feb-2009.
Abstract-Full Text-PDF Version (122 kB)
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