Quality indicators for hospital antimicrobial stewardship programmes: a systematic review

Area of Science:

• Healthcare Quality Improvement
• Infectious Disease Management
• Pharmacoeconomics

Background:

• Antimicrobial stewardship (AMS) programs are crucial for combating antimicrobial resistance.
• Measuring the quality and effectiveness of AMS programs using quality indicators (QIs) is gaining importance.
• A critical appraisal of existing QIs for hospital-based AMS programs is needed.

Purpose of the Study:

• To systematically review and identify quality indicators (QIs) for antimicrobial stewardship (AMS) programs in hospitals.
• To critically appraise the methodological quality of identified QI sets.

Main Methods:

• A systematic search of multiple databases (Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHL, Scopus/web of science) and grey literature was performed.
• Studies defining or describing the development and characteristics of QIs were included.
• The Appraisal of Indicators through Research and Evaluation (AIRE) instrument was used for methodological quality appraisal.

Main Results:

• 16 studies yielded 229 QIs for hospital AMS programs.
• The identified QIs covered diverse aspects of AMS, with 75% being process indicators, 24% structural, and 1% outcome indicators.
• Significant variation existed in the reported methodological details of the QI sets.

Conclusions:

• A notable deficiency exists in the development of outcome indicators for AMS programs.
• Future research should prioritize developing outcome indicators or linking process/structural indicators to outcomes.
• Practical testing and validation of QIs are essential components of their development process.