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Selection of hospital antimicrobial prescribing quality indicators: a consensus among German antibiotic stewardship (ABS) networkers

  • Clinical and Epidemiological Study
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Abstract

Purpose

Simple, valid, and evidence-based indicators to measure the quality of antimicrobial prescribing in acute-care hospitals are urgently needed and increasingly requested by policymakers. The aim of this study was to develop new consensus quality indicators (QIs) for hospital antibiotic stewardship (ABS) and infection management which will be further evaluated for internal quality management and external quality assessment in Germany.

Methods

Based on an extensive literature review, the Austrian–German hospital ABS Guideline Committee and selected members of the German ABS Expert Network discussed and drafted a list of 99 potential indicators for hospitals that reflect structural prerequisites for ABS (35 items), ABS core activities (18 items), additional ABS measures (5 items), and process of care indicators (both generic and disease-specific—12 and 29 items, respectively). Questionnaires were mailed to German ABS experts and healthcare professionals with further education in ABS. Participants scored (on a nine-point Likert scale) relevance (clinical, ecological/resistance, economical/expenses) and presumed practicability (six categories: clarity of definition, effort to collect data, barrier to implementation, verifiability, suitability for external quality assessment, quality gap), taking into account their local work environment. The scores were processed according to the RAND/UCLA appropriateness method, and QIs were judged relevant if the median (clinical + ecological and/or economical) scores were >6. The indicators thus assessed to be potentially relevant were then filtered according to their practicability. Highly relevant QIs with borderline practicability scores and items with disagreements and overlapping areas were re-discussed in a final multidisciplinary panel consensus workshop convened in November 2012.

Results

Of the 340 questionnaires that were mailed, 75 questionnaires were completed and returned. Of 99 initially proposed items, 32 were excluded due to insufficient scores. Of the remaining 67 items, 21 structural and 21 process of care QIs were finally selected, including four QIs with high clinical and ecological but limited economical relevance, and three QIs with high clinical and economical but limited ecological relevance. Among the selected QIs, efforts to collect data and implementation barriers were scored as suboptimal in many cases.

Conclusions

A catalog of consensus structural and process of care ABS-QIs was established. These should undergo further pilot and feasibility studies in the German hospital healthcare sector. The panelists were most critical regarding resource use/complexity issues and presumed implementation barriers. How this may limit applicability of QIs remains to be determined.

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References

  1. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM, Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.

    Article  PubMed  Google Scholar 

  2. Goff DA. Antimicrobial stewardship: bridging the gap between quality care and cost. Curr Opin Infect Dis. 2011;24[Suppl 1]:S11–20.

    Article  PubMed  Google Scholar 

  3. Davey P, Brown E, Fenelon L, Finch R, Gould I, Holmes A, Ramsay C, Taylor E, Wiffen P, Wilcox M. Systematic review of antimicrobial drug prescribing in hospitals. Emerg Infect Dis. 2006;12:211–6.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Owens RC Jr, Fraser GL, Stogsdill P, Society of Infectious Diseases Pharmacists. Antimicrobial stewardship programs as a means to optimize antimicrobial use. Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy. 2004;24:896–908.

    Article  PubMed  Google Scholar 

  5. MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev. 2005;18:638–56.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, Gaynes RP, Schlosser J, Martone WJ. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA. 1996;275:234–40.

    Article  PubMed  CAS  Google Scholar 

  7. McGowan JE. Antimicrobial stewardship—the state of the art in 2011: focus on outcome and methods. Infect Control Hosp Epidemiol. 2012;33:331–7.

    Article  PubMed  Google Scholar 

  8. Allerberger F, Gareis R, Jindrák V, Struelens MJ. Antibiotic stewardship implementation in the EU: the way forward. Expert Rev Anti Infect Ther. 2009;7:1175–83.

    Article  PubMed  Google Scholar 

  9. McNeill V, Cruickshank M, Duguid M. Safer use of antimicrobials in hospitals: the value of antimicrobial usage data. Med J Aust. 2010;193:S114–7.

    Google Scholar 

  10. Dumartin C, L’Hériteau F, Péfau M, Bertrand X, Jarno P, Boussat S, Angora P, Lacavé L, Saby K, Savey A, Nguyen F, Carbonne A, Rogues AM. Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007. J Antimicrob Chemother. 2010;65:2028–36.

    Article  PubMed  CAS  Google Scholar 

  11. Kwint HM, van der Linden PD, Roukens MM, Natsch S, SWAB’s Working Group on Surveillance of Antimicrobial Use. Intensification of antibiotic use within acute care hospitals in the Netherlands. J Antimicrob Chemother. 2012;67:2283–8.

    Article  PubMed  CAS  Google Scholar 

  12. Kuster SP, Ruef C, Ledergerber B, Hintermann A, Deplazes C, Neuber L, Weber R. Quantitative antibiotic use in hospitals: comparison of measurements, literature review, and recommendations for a standard of reporting. Infection. 2008;36:549–59.

    Article  PubMed  CAS  Google Scholar 

  13. Dumartin C, Rogues AM, Amadeo B, Pefau M, Venier AG, Parneix P, Maurain C. Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005–2008. J Hosp Infect. 2011;77:123–8.

    Article  PubMed  CAS  Google Scholar 

  14. Buyle FM, Metz-Gercek S, Mechtler R, Kern WV, Robays H, Vogelaers D, Struelens MJ, on behalf of members of the Antibiotic Strategy International (ABS) Quality Indicators Team. Development and validation of structure indicators for evaluating antimicrobial stewardship programmes in European hospitals. Eur J Clin Microbiol Infect Dis. 2013;32:1161–70.

    Article  PubMed  CAS  Google Scholar 

  15. Cooke J, Alexander K, Charani E, Hand K, Hills T, Howard P, Jamieson C, Lawson W, Richardson J, Wade P. Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother. 2010;65:2669–73.

    Article  PubMed  CAS  Google Scholar 

  16. Amadeo B, Dumartin C, Parneix P, Fourrier-Réglat A, Rogues AM. Relationship between antibiotic consumption and antibiotic policy: an adjusted analysis in the French healthcare system. J Antimicrob Chemother. 2011;66:434–42.

    Article  PubMed  CAS  Google Scholar 

  17. Schouten JA, Hulscher ME, Wollersheim H, Braspennning J, Kullberg BJ, van der Meer JW, Grol RP. Quality of antibiotic use for lower respiratory tract infections at hospitals: (how) can we measure it? Clin Infect Dis. 2005;41:450–60.

    Article  PubMed  CAS  Google Scholar 

  18. Hermanides HS, Hulscher ME, Schouten JA, Prins JM, Geerlings SE. Development of quality indicators for the antibiotic treatment of complicated urinary tract infections: a first step to measure and improve care. Clin Infect Dis. 2008;46:703–11.

    Article  PubMed  CAS  Google Scholar 

  19. German Society for Infectious Diseases (DGI). Available at: http://www.dgi-net.de/images/stories/HABS-QI%20development%20initial%20list%20of%20items%20with%20scores%20and%20comments%20and%20final%20selection_2013_09_04_final_for_website_DEUTSCH.pdf. Accessed 31 Aug 2013.

  20. German Society for Infectious Diseases (DGI). Available at: http://www.antibiotic-stewardship.de/cms/uploads/media/HABS-QI_development_initial_list_of_items.pdf. Accessed 1 Oct 2013.

  21. Afshar N, Tabas J, Afshar K, Silbergleit R. Blood cultures for community-acquired pneumonia: are they worthy of two quality measures? A systematic review. J Hosp Med. 2009;4:112–23.

    Article  PubMed  Google Scholar 

  22. Kanwar M, Brar N, Khatib R, Fakih MG. Misdiagnosis of community-acquired pneumonia and inappropriate utilization of antibiotics: side effects of the 4-h antibiotic administration rule. Chest. 2007;131:1865–9.

    Article  PubMed  Google Scholar 

  23. Morris AM, Brener S, Dresser L, Daneman N, Dellit TH, Avdic E, Bell CM. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs. Infect Control Hosp Epidemiol. 2012;33:500–6.

    Article  PubMed  Google Scholar 

  24. Society for Healthcare Epidemiology of America; Infectious Diseases Society of America; Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33:322–7.

    Article  Google Scholar 

  25. Toth NR, Chambers RM, Davis SL. Implementation of a care bundle for antimicrobial stewardship. Am J Health Syst Pharm. 2010;67:746–9.

    Article  PubMed  Google Scholar 

  26. Coupat C, Pradier C, Degand N, Hofliger P, Pulcini C. Selective reporting of antibiotic susceptibility data improves the appropriateness of intended antibiotic prescriptions in urinary tract infections: a case-vignette randomised study. Eur J Clin Microbiol Infect Dis. 2012;32:627–36.

    Article  PubMed  Google Scholar 

  27. Nguyen HB, Corbett SW, Steele R, Banta J, Clark RT, Hayes SR, Edwards J, Cho TW, Wittlake WA. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med. 2007;35:1105–12.

    Article  PubMed  Google Scholar 

  28. Pines JM, Isserman JA, Hinfey PB. The measurement of time to first antibiotic dose for pneumonia in the emergency department: a white paper and position statement prepared for the American academy of emergency medicine. J Emerg Med. 2009;37:335–40.

    Article  PubMed  Google Scholar 

  29. Pulcini C, Defres S, Aggarwal I, Nathwani D, Davey P. Design of a ‘day 3 bundle’ to improve the reassessment of inpatient empirical antibiotic prescriptions. J Antimicrob Chemother. 2008;61:1384–8.

    Article  PubMed  CAS  Google Scholar 

  30. Quattromani E, Powell ES, Khare RK, Cheema N, Sauser K, Periyanayagam U, Pirotte MJ, Feinglass J, Mark Courtney D. Hospital-reported data on the pneumonia quality measure “time to first antibiotic dose” are not associated with inpatient mortality: results of a nationwide cross-sectional analysis. Acad Emerg Med. 2011;18:496–500.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Schouten JA, Hulscher ME, Trap-Liefers J, Akkermans RP, Kullberg BJ, Grol RP, van der Meer JW. Tailored interventions to improve antibiotic use for lower respiratory tract infections in hospitals: a cluster-randomized, controlled trial. Clin Infect Dis. 2007;44:931–41.

    Article  PubMed  Google Scholar 

  32. Shorr AF, Owens RC Jr. Guidelines and quality for community-acquired pneumonia: measures from the joint commission and the centers for medicare and medicaid services. Am J Health Syst Pharm. 2009;66[12 Suppl 4]:S2–7.

    Article  PubMed  Google Scholar 

  33. Chung GW, Wu JE, Yeo CL, Chan D, Hsu LY. Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes. Virulence. 2013;4:151–7.

    Article  PubMed Central  PubMed  Google Scholar 

  34. van Kasteren ME, Mannien J, Kullberg BJ, de Boer AS, Nagelkerke NJ, Ridderhof M, Wille JC, Gyssens IC. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. J Antimicrob Chemother. 2005;56:1094–102.

    Article  PubMed  CAS  Google Scholar 

  35. von Gunten V, Troillet N, Beney J, Boubaker K, Lüthi JC, Taffé P, Reymond JP. Impact of an interdisciplinary strategy on antibiotic use: a prospective controlled study in three hospitals. J Antimicrob Chemother. 2005;55:362–6.

    Article  CAS  Google Scholar 

  36. Zvonar RK, Bush P, Roth V. Practice changes to improve delivery of surgical antibiotic prophylaxis. Healthc Q. 2008;11(3 Spec No.):141–4.

    Article  PubMed  Google Scholar 

  37. Zarb P, Amadeo B, Muller A, Drapier N, Vankerckhoven V, Davey P, Goossens H, ESAC-3 Hospital Care Subproject Group. Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC point prevalence survey 2009. J Antimicrob Chemother. 2011;66:443–9.

    Article  PubMed  CAS  Google Scholar 

  38. Buyle FM, Metz-Gercek S, Mechtler R, Kern WV, Robays H, Vogelaers D, Struelens MJ, Antibiotic Strategy International-ABS Quality Indicators Team. Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics. J Antimicrob Chemother. 2012;67:2043–6.

    Article  PubMed  CAS  Google Scholar 

  39. Kern WV, Metz-Gercek S, Buyle F, et al. Staphylococcus aureus blood-stream infection management indicators as quality indicators for hospital antibiotic stewardship: feasibility study by the ABS International Quality Indicators (ABS QI) team. Congress of clinical microbiology and infectious diseases, Helsinki May 2009 [abstract #P764]. Clin Microbiol Infect. 2009;15[Suppl 4]:S188.

    Google Scholar 

  40. Malcolm W, Nathwani D, Davey P, Cromwell T, Patton A, Reilly J, Cairns S, Bennie M. From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals. Antimicrob Resist Infect Control. 2013;2:3.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Nathwani D, Sneddon J, Malcolm W, Wiuff C, Patton A, Hurding S, Eastaway A, Seaton RA, Watson E, Gillies E, Davey P, Bennie M. Scottish antimicrobial prescribing group (SAPG): development and impact of the Scottish national antimicrobial stewardship programme. Int J Antimicrob Agents. 2011;38:16–26.

    Article  PubMed  CAS  Google Scholar 

  42. Scottish Antimicrobial Prescribing Group (SAPG). CDI HEAT Target (CEL April 2009)—Hospital-based empirical prescribing national report. NHS Scotland, April 2011. Available at: http://www.scottishmedicines.org.uk/files/SAPG_Antimicrobial_Supporting_Indicators_Report_-_April_2011.pdf. Accessed 8 Feb 2013.

  43. Scottish Antimicrobial Prescribing Group (SAPG). Good practice recommendations for hospital antimicrobial stewardship in NHS Scotland. NHS Scotland, April 2012. Available at: http://www.scottishmedicines.org.uk/files/sapg/Good_practice_recommendations_for_hospital_antimicrobial_stewardship_2012.pdf. Accessed 8 Feb 2013.

  44. Duguid M, Cruickshank M, editors. Antimicrobial stewardship in Australian hospitals. Sydney: Australian Commission on Safety and Quality in Health Care; 2011.

    Google Scholar 

  45. Australian Commission on Safety and Quality in Health Care. Safety and quality improvement guide standard 3: preventing and controlling healthcare associated infections. ACSQHC, Sydney, 2012. Available at: http://www.safetyandquality.gov.au/publications/rtf-safety-and-quality-improvement-guide-standard-3-preventing-and-controlling-healthcare-associated-infections/ Accessed 15 Feb 2013.

  46. Saizy-Callaert S, Causse R, Furhman C, Le Paih MF, Thébault A, Chouaïd C. Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital. J Hosp Infect. 2003;53:177–82.

    Article  PubMed  CAS  Google Scholar 

  47. Van Gastel E, Costers M, Peetermans WE, Struelens MJ, Hospital Medicine Working Group of the Belgian Antibiotic Policy Coordination Committee. Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting survey. J Antimicrob Chemother. 2010;65:576–80.

    Article  PubMed  CAS  Google Scholar 

  48. Ho PL, Cheng JC, Ching PT, Kwan JK, Lim WW, Tong WC, Wu TC, Tse CW, Lam R, Yung R, Seto WH, Consensus Meeting Group on Antimicrobial Stewardship Programme. Optimising antimicrobial prescription in hospitals by introducing an antimicrobial stewardship programme in Hong Kong: consensus statement. Hong Kong Med J. 2006;12:141–8.

    PubMed  CAS  Google Scholar 

  49. Cookson B, Mackenzie D, Coutinho AP, Russell I, Fabry J. Consensus standards and performance indicators for prevention and control of healthcare-associated infection in Europe. J Hosp Infect. 2011;79:260–4.

    Article  PubMed  CAS  Google Scholar 

  50. Kritchevsky SB, Braun BI, Bush AJ, Bozikis MR, Kusek L, Burke JP, Wong ES, Jernigan J, Davis CC, Simmons B, TRAPE Study Group. The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial. Ann Intern Med. 2008;149:472–80.

    Article  PubMed  Google Scholar 

  51. Reiter A, Fischer B, Kötting J, Geraedts M, Jäckel WH, Döbler K. QUALIFY: Ein Instrument zur Bewertung von Qualitätsindikatoren. Z Ärztl Fortbild Qualitatssich. 2007;101:683–8.

    PubMed  Google Scholar 

  52. Nothacker M, Reiter A. Qualitätsindikatoren für Nationale VersorgungsLeitlinien. In: ÄZQ (Hrsg.) Programm für Nationale VersorgungsLeitlinien von BÄK, KBV und AWMF—Qualitätsindikatoren. Manual für Autoren. Berlin: ÄZQ; 2009; pp 18–31.

  53. Fitch K, Bernstein S, Aguilar M, Burnand B, LaCalle J, Lazaro P: The RAND/UCLA appropriateness method user’s manual. Santa Monica: RAND Corp; 2003. Available at: http://www.rand.org/pubs/monograph_reports/MR1269.html. Accessed 24 April 2012.

  54. Davies S, Romano PS, Schmidt EM, Schultz E, Geppert JJ, McDonald KM. Assessment of a novel Hybrid Delphi and nominal groups technique to evaluate quality indicators. Health Serv Res. 2011;46:2005–18.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Boulkedid R, Abdoul H, Loustau M, Sibony O, Alberti C. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011;6:e20476.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  56. Bero LA, et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998;317:465.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  57. Campbell SM, Shield T, Rogers A, Gask L. How do stakeholder groups vary in a Delphi technique about primary mental health care and what factors influence their ratings? Qual Saf Health Care. 2004;13:428–34.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  58. Kahan JP, Park RE, Leape LL, Bernstein SJ, Hilborne LH, Parker L, Kamberg CJ, Ballard DJ, Brook RH. Variations by specialty in physician ratings of the appropriateness and necessity of indications for procedures. Med Care. 1996;34:512–23.

    Article  PubMed  CAS  Google Scholar 

  59. Campbell SM, Hann M, Roland MO, Quayle JA, Shekelle PG. The effect of panel membership and feedback on ratings in a two-round Delphi survey: results of a randomized controlled trial. Med Care. 1999;37:964–8.

    Article  PubMed  CAS  Google Scholar 

  60. Reiter A, Geraedts M, Jäckel W, Fischer B, Veit C, Döbler K. Selection of hospital quality indicators for public disclosure in Germany. Z Evid Fortbild Qual Gesundhwes. 2011;105:44–8.

    Article  PubMed  Google Scholar 

  61. Kuske S, Lessing C, Lux R, Schmitz A, Schrappe M. Patient safety indicators for medication safety (AMTS-PSI): international status, transferability and validation. Gesundheitswesen. 2012;74:79–86.

    Article  PubMed  CAS  Google Scholar 

  62. Jacob JT, Gaynes RP. Emerging trends in antibiotic use in US hospitals: quality, quantification and stewardship. Expert Rev Anti Infect Ther. 2010;8:893–902.

    Article  PubMed  Google Scholar 

  63. Trivedi KK, Rosenberg J. The state of antimicrobial stewardship programs in California. Infect Control Hosp Epidemiol. 2013;34:379–84.

    Article  PubMed  Google Scholar 

  64. Johannsson B, Beekmann SE, Srinivasan A, Hersh AL, Laxminarayan R, Polgreen PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol. 2011;32:367–74.

    Article  PubMed  Google Scholar 

  65. Bruce J, MacKenzie FM, Cookson B, Mollison J, van der Meer JW, Krcmery V, Gould IM, ARPAC Steering Group. Antibiotic stewardship and consumption: findings from a pan-European hospital study. J Antimicrob Chemother. 2009;64:853–60.

    Article  PubMed  CAS  Google Scholar 

  66. Nault V, Beaudoin M, Thirion DJ, Gosselin M, Cossette B, Valiquette L. Antimicrobial stewardship in acute care centres: a survey of 68 hospitals in Quebec. Can J Infect Dis Med Microbiol. 2008;19:237–42.

    PubMed Central  PubMed  Google Scholar 

  67. AQUA–Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH. Ambulant erworbene Pneumonie—Qualitätsindikatoren 2011. AQUA, Göttingen, 2012. Available at: https://www.sqg.de/downloads/QIDB/2011/AQUA_PNEU_Indikatoren_2011.pdf. Accessed 8 Feb 2013.

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Acknowledgments

We would like to thank the members of the German ABS Network who participated in the workshops and survey. The Austrian–German Hospital ABS Guideline Committee has been supported by the German Society for Infectious Diseases (DGI), the Paul-Ehrlich-Society for Chemotherapy (PEG), the National Association of Hospital Pharmacists (ADKA), the Austrian Society for Antimicrobial Chemotherapy (ÖGACH), the Austrian Society for Infectious Diseases and Tropical Medicine (ÖGIT), the Austrian Hospital Pharmacists Association and the former Austrian ABS Group. The German ABS Network is supported by the German Society for Infectious Diseases (DGI) and the National Association of Hospital Pharmacists (ADKA). KdW and NW were supported in part by Grants from the German Ministry of Health (BMG).

Conflict of interest

None declared.

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Authors and Affiliations

  1. University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    J. Thern

  2. University Medical Center Freiburg, Freiburg, Germany

    K. de With, M. Steib-Bauert, N. Weber & W. V. Kern

  3. University Hospital Erlangen, Erlangen, Germany

    R. Strauss

  4. Abteilung Infektiologie, Universitätsklinikum, Hugstetter Straße 55, 79100, Freiburg, Germany

    W. V. Kern

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For the German ABS Expert Network, and the Austrian–German Hospital ABS Guideline Committee.

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Thern, J., de With, K., Strauss, R. et al. Selection of hospital antimicrobial prescribing quality indicators: a consensus among German antibiotic stewardship (ABS) networkers. Infection 42, 351–362 (2014). https://doi.org/10.1007/s15010-013-0559-z

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