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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