Easy-to-measure, actionable feedback on the quality of hospital antibiotic use Jaap ten Oever receives ZonMw grant of 500,000 euros

With a €500,000 ZonMw grant from the Antimicrobial Resistance 3 program, a team led by Jaap ten Oever, Jeroen Schouten, and Marlies Hulscher is developing easy-to-measure, actionable feedback on hospital antibiotic use quality over a 4-year research project.

The researchers, affiliated with the Radboudumc Community for Infectious Diseases (RCI) and the Research Program Optimal Infectious Disease Care and Outbreak Response, are collaborating with LUMC (Mark de Boer and Martine Caris) on this initiative. The project focuses on creating novel proxy indicators from quantitative data to enhance antibiotic stewardship in Dutch hospitals.

Dutch hospitals have established antimicrobial stewardship teams responsible for improving the quality, i.e., the appropriateness, of antibiotic use. However, measuring quality indicators is often time-consuming, and identifying improvement targets based on quantity metrics alone is challenging. The research team plans to use novel, easy-to-measure metrics, known as proxy indicators, which fall between quantity and quality metrics. These indicators will be derived from readily available quantitative data that, with some adjustments, can approximate the quality of antibiotic use.

The project will begin by identifying proxy indicators of appropriate antibiotic use from international literature, followed by a Delphi procedure to achieve expert consensus. The feasibility of these indicators will then be tested using existing Dutch antimicrobial databases. Finally, a feedback prototype will be co-created with future users, incorporating expert input and evidence from Dutch hospitals.

Ultimately, the aim is to develop easily measurable and actionable indicators that Dutch stewardship teams can use to improve antibiotic use, thereby contributing to the fight against antimicrobial resistance.

Follow-up care for patients discharged from the emergency department

In a related 2-year research project funded by a €100,000 ZonMw grant, Jaap ten Oever, Renée Tuinte, Jacobien Hoogerwerf, Heiman Wertheim, and Marlies Hulscher will investigate follow-up care for patients with urinary tract infections discharged from emergency departments. Conducted within the Radboudumc Community for Infectious Diseases (RCI) and the Research Program Optimal Infectious Disease Care and Outbreak Response, this study will evaluate current practices and determinants of follow-up care in six Dutch hospitals.

Patients who present to the emergency department with a suspected infection and are sent home after assessment and treatment, are often overlooked. Follow-up appointments may not be scheduled, and therefore necessary adjustments in treatment may not be made. However, addressing this issue is critical because culture results may show, for example, that antibiotics are not necessary after all, and a patient may then be exposed to antibiotics unnecessarily. This is not only harmful to the patient because of potential side effects, but also contributes to the growing problem of antimicrobial resistance. To better understand this problem, we will evaluate follow-up care of patients with urinary tract infections discharged from the emergency department in 6 Dutch hospitals and explore the determinants of adequate follow-up care based on interviews with stakeholders.

The findings will inform the development of a follow-up program, addressing a critical gap in patient care that impacts both individual health outcomes and the broader issue of antimicrobial resistance.