ABSTRACT
Hintergrund Diese Studie beschreibt die Entwicklung und Validierung von Strukturindikatoren für das klinisch-infektiologische Versorgungsangebot in deutschen Krankenhäusern. Ein solches ist notwendig, um den künftigen Herausforderungen in der Infektionsmedizin adäquat begegnen zu können. Methode Ein Expert*innenteam entwickelte die Strukturindikatoren im Rahmen eines dreistufigen Entscheidungsverfahrens: (1) Identifizierung potenzieller Strukturindikatoren basierend auf einer Literaturrecherche, (2) schriftliches Bewertungsverfahren sowie eine (3) persönliche Diskussion zur Konsensfindung und finalen Auswahl geeigneter Strukturindikatoren. Zur Pilotierung der entwickelten Strukturindikatoren wurde eine Feldstudie durchgeführt. Ein auf den Strukturindikatoren basierender Score wurde für jedes Krankenhaus ermittelt und über eine Receiver-Operator-Charakteristik-Kurve (ROC) anhand extern validierter infektiologischer Expertise (Zentrum der Deutschen Gesellschaft für Infektiologie [DGI]) validiert. Ergebnisse Auf der Basis einer Liste von 45 potenziellen Strukturindikatoren wurden 18 geeignete Strukturindikatoren für das klinisch-infektiologische Versorgungsangebot entwickelt. Von diesen wurden zehn Schlüsselindikatoren für das allgemeine bzw. Coronavirus-Krankheit-2019 (COVID-19)-spezifische klinisch-infektiologische Versorgungsangebot definiert. Bei der Felderhebung des Versorgungsangebots für COVID-19-Patient*innen in 40 deutschen Krankenhäusern erreichten die teilnehmenden Einrichtungen 0 bis 9 Punkte (Median 4) im ermittelten Score. Die Fläche unter der ROC-Kurve betrug 0,893 (95%-Konfidenzintervall (KI): 0,797, 0,988;p < 0,001). Diskussion/Schlussfolgerung Die im Rahmen eines transparenten und etablierten Entwicklungsprozesses entwickelten Strukturindikatoren können perspektivisch genutzt werden, um den aktuellen Zustand und zukünftige Entwicklungen der infektiologischen Versorgungsqualität in Deutschland zu erfassen und Vergleiche zu ermöglichen.
ABSTRACT
INTRODUCTION: This study describes the development and validation of structure indicators for clinical infectious disease (ID) care in German hospitals, which is important to adequately face the future challenges in ID medicine. METHODS: A team of experts developed the structure indicators in a three-stage, multicriteria decision-making process: (1) identification of potential structure indicators based on a literature review, (2) written assessment process, and (3) face-to-face discussion to reach consensus and final selection of appropriate structure indicators. A field study was conducted to assess the developed structure indicators. A score based on the structure indicators was determined for each hospital and validated via receiver operator characteristic (ROC) curves using externally validated ID expertise (German Society of ID (DGI) Centre). RESULTS: Based on a list of 45 potential structure indicators, 18 suitable indicators were developed for clinical ID care structures in German hospitals. Out of these, ten key indicators were defined for the general and coronavirus disease 2019- (COVID-19-) specific clinical ID care structures. In the field survey of clinical ID care provision for COVID-19 patients in 40 German hospitals, the participating facilities achieved 0 to 9 points (median 4) in the determined score. The area under the ROC curve was 0.893 (95% CI: 0.797, 0.988; pâ¯<â¯0.001). DISCUSSION/CONCLUSION: The structure indicators developed within the framework of a transparent and established development process can be used in the future to both capture the current state and future developments of ID care quality in Germany and enable comparisons.
Subject(s)
COVID-19 , Communicable Diseases , Humans , Germany , Pandemics , HospitalsABSTRACT
PURPOSE: Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. METHODS: 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. RESULTS: Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). CONCLUSION: In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.