Indicadores de calidad y de uso de antimicrobianos en pacientes críticos

Abstract

INTRODUCTION The quality indicators are monitoring systems which applied to health care, allow to analyze and quantify objectively how the asistance is done. Quality indicators for antimicrobial (ATM) use in critically ill patients, are defined to assess relevant aspects regarding the global consumption, the adequacy of treatment or duration. The national surveillance study of nosocomial infection (ENVIN) accounting records of all ATM used in critically ill patients during the study period. OBJECTIVES Define and develop quality indicators on ATM use in critically ill patients and to quantify and assess its evolution over the last 10 years from ENVIN study records for the years 2001-2010 to identify quality problems. MATERIAL AND METHODS Part One: definition of indicators according to the following scheme: flag, formula, definition of terms, type (structure, process, outcome), basis, population, data collection, data source, frequency, standard and comments. Part Two: retrospective study of the results of the indicators from ENVIN registry data (2001-2010). Quantitative variables were expressed as mean and standard deviation and were analyzed by analysis of variance Qualitative variables are expressed as percentage of the different categories and were analyzed by linear association test chi square tests, with 0.005 statistical significance because of the large sample size. Statistical analysis was performed using SPSS (version 19.0 Inc. Chicago, IL). RESULTS We have defined and developed the following indicators. Numerical quality indicators: 1. ATM usage in intensive care unit (ICU) rate. 2. Non empirical ATM rate. 3. ATM used in treatment, changed rate. 4. Selective digestive decontamination utilization rate. 5. Rate of days without use of ATM in ICU. 6. Days without utilization of ATM, on patients with infection or ATM treatment rate. Quality indicators on the appropriate use of ATM: 1. Number of days of ATM treatment used prophylactically. 2. ATM used in empirical treatment, inappropriate rate. 3. ATM used empirically changed by inadequate treatment, rate. 4. ATM used empirically changed by de-escalation, rate. 5. Delayed start of antifungal treatment in patients diagnosed with candidemia. Indicators on the use of ATM by families: 1. Rate glycopeptides vs linezolid / daptomycin. 2. Rate cephalosporins 3rd / 4th generation vs carbapenems. 3. Rate colistin. We analyzed the results of the indicators based on data from 103,415 patients enrolled in the registry ENVIN that over the decade studied, received 135,105 ATM. Found statistically significant trends regarding the use of ATM. CONCLUSIONS Fourteen indicators are defined. There were found improving situations, positive changes and trends in the consumption of certain families of ATM over the decade 2001-2010.

Date of Award	10 Dec 2012
Original language	Spanish
Supervisor	Francisco Alvarez Lerma (Director) & Adolfo Diez Perez (Tutor)