Research Articles from the SHS-UHN ASP (Category)

Use of a structured panel process to define antimicrobial prescribing appropriateness in critical care

LD Dresser
CM Bell
M Steinberg
ND Ferguson
S Lapinsky
N Lazar
P Murphy
JM Singh
AM Morris



Background:  Antimicrobial prescribing is frequently reported as appropriate or inappropriate, particularly in the ICU.  However, the definitions used are non-standardized and lack validity and reliability.

Objectives:  To develop standardized definitions of appropriateness for antimicrobial prescribing in the critical care setting.

Methods:  We used consensus-based modified Delphi and RAND appropriateness methodology to develop criteria to define appropriateness of antimicrobial prescribing.  A multiphased approach with an online questionnaire followed by a facilitated in-person meeting was utilized and included clinicians from a variety of practice areas (e.g. surgeons, infectious diseases specialists, intensivists, transplant specialists and pharmacists).

Results:  There were a total of 23 criteria agreed upon to define the following categories of antimicrobial prescribing:  appropriate; effective but unnecessary; inappropriate; and under-treatment.

Conclusions:  These standardized criteria for appropriateness may be generalizable to other patient populations and utilized with other tools to adjudicate prescribing practices.


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