Practice testing of generic quality indicators for responsible antibiotic use in nine hospitals in the Dutch–Belgian border area

Background: Inpatient quality indicators (IQIs) were previously developed to assess responsible antibiotic use. Aim: Practice testing of these QIs in the hospital setting. Method: This study was performed within a DutcheBelgian border network of hospitals implementing the Infection Risk Scan (IRIS) point prevalence survey (PPS) as part of the i4-1-Health project. Twenty out of 51 DRIVE-AB IQIs, including 13 structure and seven process IQIs, were tested. Data on structure IQIs were obtained through a web-based questionnaire sent to the hospital medical microbiologists. PPS data from October to December 2018 were used to calculate performance scores for the process QIs. Findings: Nine hospitals participated. Regarding structure IQIs: the lowest performance scores were observed for recommendations for microbiological investigations in the guidelines and the use of an approval system for restricted antibiotics. In addition, most hospitals reported that some antibiotics were out of stock due to shortages. Regarding process IQIs: 697 systemic antibiotic prescriptions were used to calculate performance scores. The lowest score was observed for documentation of an antibiotic plan in the medical file (58.8%). Performance scores for IQIs on guideline compliance varied between 74.1% and 82.3% for different aspects of the antibiotic regimen (duration, choice, route, timing). Conclusion: This multicentre practice testing of IQIs identified improvement targets for stewardship efforts for both structure and process aspects of antibiotic care (approval system for restricted antibiotics, documentation of antibiotic plan). These results can guide the design of future PPS studies and a more extensive evaluation of the clinimetric properties of the IQIs. The i-4-1-Health project was financed by the Interreg V Flanders e The Netherlands programme, the cross-border cooperation programme with financial support from the European Regional Development Fund (ERDF) (0215). Additional financial support was received from the Dutch Ministry of Health, Welfare and Sport (325911), the Dutch Ministry of Economic Affairs (DGNR-RRE/14191181), the Province of Noord-Brabant (PROJ-00715/PROJ-01018/PROJ-00758), the Belgian Department of Agriculture and Fisheries (no reference), the Province of Antwerp (1564470690117/1564470- 610014) and the Province of East-Flanders (E01/subsidie/ VLNL/i-4-1-Health). The authors are free to publish the results from the project without interference from the funding bodies. The authors thank all the stakeholders (infection control practitioners, pharmacists, ID physicians, residents, and microbiologists) for the collection of the epidemiological data. The authors acknowledge the participants to the questionnaire and thank all the members of the i-4-1-Health Study Group (see Supplementary Appendix A).