TABLE 3

Adherence and room for improvement for QIs

QIApplicability (no. of patients/
total no. of patients evaluated
[% [95% CI]])
Adherence (no. of patients/
total no. of patients [% [95% CI]])
Room for improvementa
(% [95% CI])
Empirical antibiotic therapy according to local guidelines135/362 (37.3 [32.5–42.4])94/135 (69.6 [61.4–76.8])30.4 (23.2–38.6)
Adequate request for blood cultures353/362 (97.5 [95.3–98.7])139/353 (39.4 [34.4–44.6])60.6 (55.4–65.6)
Adequate request for culture from site of infection269/362 (74.3 [69.6–78.5])215/269 (79.9 [74.7–84.3])20.1 (15.7–25.3)
Antibiotic treatment directed to culture results106/362 (29.3 [24.8–34.2])97/106 (91.5 [84.7–95.5])8.5 (4.53–15.4)
Sequential antibiotic therapy within 72 hb220/362 (60.8 [55.7–65.7])114/220 (51.8 [45.2–58.3])48.18 (41.7–54.8)
Patients receiving unnecessary antibiotic treatment in the absence
of clinical or microbiological evidencec
254/362 (70.2 [65.3–74.7])d31/254 (12.20 [8.73–16.8])12.20 (8.73–16.8)
Dosage adjusted for renal function68/362 (18.8 [15.1–23.1])53/68 (77.9 [66.7–86.2])22.1 (13.9–33.3)
TDM22/362 (6.1 [4.10–9.03])9/22 (40.9 [23.3–61.3])59.1 (38.7–76.7)
  • a Calculated as 100 − adherence.

  • b Criteria for safe switching within 72 h of treatment were as follows: (i) hemodynamically stable; (ii) no fever; (iii) normal white blood cell count (4 × 109 to 12 × 109 cells/liter); (iv) able to take oral medication; and (v) functioning gastrointestinal tract, without signs of malabsorption. A safe switch was not possible in cases of meningitis, intracranial abscesses, endocarditis, mediastinitis, Legionella pneumonia, exacerbations of cystic fibrosis, inadequately drained abscesses with empyema, severe soft tissue infections such as group A streptococcal infections, infections of foreign bodies, Staphylococcus aureus or Pseudomonas aeruginosa bacteremia, liver abscesses with empyema, osteomyelitis or arthritis, or chemotherapy-related neutropenia.

  • c This QI has a negative formulation. Therefore, in this case, adherence and room for improvement have the same numerical value.

  • d Patients on the fifth day of antibiotic treatment.