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.
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.
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DOI：
10.1086/677633
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发表时间：
2014-09
影响因子：
4.5
通讯作者：
Samore M
中科院分区：
文献类型：
--
作者：
Madaras-Kelly K;Jones M;Remington R;Hill N;Huttner B;Samore M
开发一种用于测量抗生素方案微生物谱的数值评分(频谱评分)以及基于该评分的应用来识别抗生素降级事件的方法。基于Web的改进德尔菲法。在美国执业的医生和药剂师通过专注于传染病的名单招募。德尔福调查了三轮：将生物体和抗生素纳入光谱评分，评分规则的可操作性，以及降级测量。用4分序数表对机体-抗生素区域对的抗生素敏感性进行评分。抗生素方案评分，代表一个方案中抗生素在所有生物体领域的综合活性，用于比较治疗早期(第2天)和晚些时候(第4天)给予的抗生素谱。计算频谱分数的变化，并将其与德尔福参与者对20种抗生素方案的降级判断以及与非德尔福管理人员对300种肺炎方案降级的判断进行比较。方法计算预测专家降级状态的灵敏度和特异度。24名参与者完成了德尔福的所有回合。确定了对公制开发中使用的概念的专家支持。对于Delphi中呈现的小片段，除了涉及口服抗生素替代的小片段外，所有小片段中分数变化的迹象都正确地归类为降级。该方法识别非德尔菲管家判断的降级事件的灵敏度和特异度分别为86.3%和96.0%。根据一种算法识别降级事件，该算法测量抗生素方案的微生物谱，通常与管家对降级状态的判断一致。
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. Web-based modified Delphi method. Physician and pharmacist antimicrobial stewards practicing in the United States recruited through infectious diseases–focused listservs. 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. 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. 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.