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Development of an Antibiotic Spectrum Score Based on Veterans Affairs Culture and Susceptibility Data for the Purpose of Measuring Antibiotic De-Escalation: A Modified Delphi Approach

Published online by Cambridge University Press:  10 May 2016

Karl Madaras-Kelly ,
Makoto Jones ,
Richard Remington ,
Nicole Hill ,
Benedikt Huttner  and
Matthew Samore
Karl Madaras-Kelly*
Affiliation:
Veterans Affairs Medical Center, Boise, Idaho College of Pharmacy, Idaho State University, Meridian, Idaho
Makoto Jones
Affiliation:
George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah; and Division of Epidemiology, University of Utah, Salt Lake City, Utah
Richard Remington
Affiliation:
Veterans Affairs Medical Center, Boise, Idaho Quantified, Boise, Idaho
Nicole Hill
Affiliation:
Division of Health Sciences, Idaho State University, Pocatello, Idaho
Benedikt Huttner
Affiliation:
George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah; and Division of Epidemiology, University of Utah, Salt Lake City, Utah Division of Health Sciences, Idaho State University, Pocatello, Idaho
Matthew Samore
Affiliation:
George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah; and Division of Epidemiology, University of Utah, Salt Lake City, Utah
*
Idaho State University, 1311 East Central Drive, Meridian, ID 83642 (kmk@pharmacy.isu.edu).
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Extract

Objective

Development of a numerical score to measure the microbial spectrum of antibiotic regimens (spectrum score) and method to identify antibiotic de-escalation events based on application of the score.

Design

Web-based modified Delphi method.

Participants.

Physician and pharmacist antimicrobial stewards practicing in the United States recruited through infectious diseases–focused listservs.

Methods

Three Delphi rounds investigated: organisms and antibiotics to include in the spectrum score, operationalization of rules for the score, and de-escalation measurement. A 4-point ordinal scale was used to score antibiotic susceptibility for organism-antibiotic domain pairs. Antibiotic regimen scores, which represented combined activity of antibiotics in a regimen across all organism domains, were used to compare antibiotic spectrum administered early (day 2) and later (day 4) in therapy. Changes in spectrum score were calculated and compared with Delphi participants’ judgments on de-escalation with 20 antibiotic regimen vignettes and with non-Delphi steward judgments on de-escalation of 300 pneumonia regimen vignettes. Method sensitivity and specificity to predict expert de-escalation status were calculated.

Results

Twenty-four participants completed all Delphi rounds. Expert support for concepts utilized in metric development was identified. For vignettes presented in the Delphi, the sign of change in score correctly classified de-escalation in all vignettes except those involving substitution of oral antibiotics. The sensitivity and specificity of the method to identify de-escalation events as judged by non-Delphi stewards were 86.3% and 96.0%, respectively.

Conclusions

Identification of de-escalation events based on an algorithm that measures microbial spectrum of antibiotic regimens generally agreed with steward judgments of de-escalation status.

Infect Control Hosp Epidemiol 2014;35(9):1103-1113

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1103 - 1113
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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