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Table 2 Quality assessment of outcome measurement instruments

From: Development of a core outcome set for clinical trials aimed at improving antimicrobial stewardship in care homes

Outcome

Outcome measurement instrument

Objective/Subjective

Overall quality of evidence

The total number of antimicrobial courses prescribed

(1) Number of antimicrobial courses started per 1000 resident-days [16,17,18]

Objective

 + 

(2) Number of antibiotic transactions per 1000 resident-days [19]

Objective

?

(3) Point prevalence of antimicrobial use [20]

Objective

?

(4) Total number of antimicrobial courses [21]

Objective

?

(5) Mean number of residents treated with antimicrobial per month [22]

Objective

?

Appropriateness of antimicrobial prescribing

(6) Loeb minimum criteria for initiating antibiotic therapy in SSTIs, RTIs, UTIs, fever where the focus of infection is unknown [23]

Subjective

?

(7) Revisited McGeer criteria for diagnosing infection: SSTIs, RTIs, UTIs, gastrointestinal tract infections, systemic infections [24, 25]

Subjective

-

(8) Crnich algorithm for the initiation of antibiotics for UTIs [26]

Subjective

-

(9) Van Buul algorithms to evaluate appropriateness of initiating or withholding antibiotics in SSTIs, RTIs, UTIs [27]

Subjective

?

(10) The Medication Appropriateness Index [28, 29]

Subjective

-

Days of therapy per 1000 resident-days

(11) Rate of antimicrobial days of therapy per 1000 resident-days [16,17,18]

Objective

 + 

(12) Antibiotic utilization ratio [16,17,18]

Objective

?

Rate of antimicrobial resistance

(13) Number of cases with specific (non-) resistant organisms [30]

Subjective

-

(14) Number of specific (non-) resistant isolates/ organisms [31, 32]

Subjective

-

(15) Drug Resistance Index [33]

Subjective

-

Mortality related to infection

(16) Rate of mortality related to infection per 1000 resident-days [34]

Subjective

-

(17) Proportion of mortality related to infection [30]

Subjective

-

  1. +, positive rating; ?, indeterminate rating; −, negative rating
  2. RTIs, respiratory tract infections; SSTIs, skin and soft tissue infections; UTIs, urinary tract infections