Development and applicability assessment of a 5R-principle-guided evaluation system for antimicrobial stewardship in...

Open extremity trauma is associated with a high risk of infection, making appropriate antimicrobial use essential. However, existing stewardship tools are often generic and lack a structured, hierarchical evaluation system tailored to this setting.

We developed an initial indicator set based on the 5R principles (Right Patient, Right Drug, Right Dose, Right Time, and Right Route). A national panel of 42 experts participated in two rounds of a modified Delphi survey using a 5-point Likert scale to rate indicator importance. The analytic hierarchy process (AHP) was used to assign indicator weights. The finalized system was preliminarily assessed in a retrospective cohort from the Hand and Foot Surgery Department at the Lequn Campus, First Hospital of Jilin University, comparing a pharmacist-led intervention group with a routine-care control group.

Response rates were 100% in both Delphi rounds, and the expert authority coefficient was 0.87. Across the two rounds, Kendall's W values ranged from 0.044 to 0.110 for secondary and tertiary indicators, with all P < 0.05, demonstrating statistically significant expert agreement. All indicators met predefined consensus criteria (mean score ≥ 4.0; coefficient of variation ≤ 0.25). The final system comprised 5 primary, 11 secondary, and 22 tertiary indicators; all AHP consistency ratios were < 0.1. In the preliminary applicability assessment, the intervention group achieved higher appropriateness scores (P=0.004) and lower total antimicrobial costs (P<0.001) than the control group.

A 5R-guided, Delphi-AHP-derived evaluation system was developed and preliminarily validated. The tool can support standardized assessment and targeted pharmacist-led antimicrobial stewardship in open extremity trauma.