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J Antimicrob Chemother. 2018 Jan 1;73(1):246-249. doi: 10.1093/jac/dkx341.

Use of a structured panel process to define antimicrobial prescribing appropriateness in critical care.

Author information

1
University Health Network, 101 College St., Toronto, Ontario M5G 1L7, Canada.
2
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, Ontario M5S 3M2, Canada.
3
Sinai Health System, 600 University Ave., Toronto, Ontario M5G 1X5, Canada.
4
Department of Medicine, University of Toronto, 200 Elizabeth St., Suite RFE 3-805, Toronto, Ontario M5G 2C4, Canada.
5
Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., G1-06, Toronto, Ontario M4N 3M5, Canada.
6
Department of Anesthesia, University of Toronto, 123 Edward St., Room 1200, Toronto, Ontario M5G 1E2, Canada.

Abstract

Background:

Antimicrobial prescribing is frequently reported as appropriate or inappropriate, particularly in the ICU. However, the definitions used are non-standardized and lack validity and reliability.

Objectives:

To develop standardized definitions of appropriateness for antimicrobial prescribing in the critical care setting.

Methods:

We used consensus-based modified Delphi and RAND appropriateness methodology to develop criteria to define appropriateness of antimicrobial prescribing. A multiphased approach with an online questionnaire followed by a facilitated in-person meeting was utilized and included clinicians from a variety of practice areas (e.g. surgeons, infectious diseases specialists, intensivists, transplant specialists and pharmacists).

Results:

There were a total of 23 criteria agreed upon to define the following categories of antimicrobial prescribing: appropriate; effective but unnecessary; inappropriate; and under-treatment.

Conclusions:

These standardized criteria for appropriateness may be generalizable to other patient populations and utilized with other tools to adjudicate prescribing practices.

PMID:
29029170
DOI:
10.1093/jac/dkx341
[Indexed for MEDLINE]

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