Quality indicators for the use of antimicrobial agents in hospitals

The purposes of this article were to summarize the available information about the evaluation of antimicrobial prescribing practices in hospitals and to justify the need to establish and to define standardized quality of prescriptions indicators in order to improve the use of antibiotics into health systems. Currently, the reference method to express antibiotic exposure has been and continues to be the ATC/DDD methodology. However, these indicators only provide quantitative information and it should be supplemented with other tools which provide qualitative information on it to achieve a global vision about the use of antibiotics. In primary care, European disease-specific Antibiotic Prescribing Quality Indicators (APQI) were proposed for seven acute indications, but, as far as the authors know in hospitals, nowadays there is not any validated and standardized method to measure the quality of prescriptions of antimicrobial agents in hospitals. We conducted a literature search in Pubmed (MEDLINE) and EMBASE database. Only some articles have suggested quality indicators for the management of community-acquired infections, but not in hospitals. Therefore, we proposed some quality indicators of the use of antimicrobial agents through a ratio based on the indicators of primary care and the optimization of antimicrobial therapy (as modified quantitative assessment). It is essential to keep track of the value of these quality indicators at the same time as the patterns of resistance/sensitivity of microorganisms. Moreover, these indicators must be validated both internally and externally in order to implement them into practice