JAC Antimicrob Resist. 2026 Sep 1;8(4):dlag195. doi: 10.1093/jacamr/dlag195. eCollection 2026 Aug.
ABSTRACT
BACKGROUND: Scalable measures that capture post-diagnostic antibiotic decisions are lacking. We developed and validated the guidance ratio (GR), a registry-based measure of post-diagnostic antibiotic decision-making.
METHODS: We conducted a retrospective multi-centre validation study of the GR and discontinuation ratio (DR), two registry-based indicators of post-diagnostic antibiotic decision-making in paediatric febrile urinary tract infection. Prescribing outcomes were classified using rule-based algorithms and compared with manually classified outcomes from medical record review. Indicator performance was evaluated against medical record data used as the reference standard.
RESULTS: Among 909 episodes, the GR identified guided treatment with a sensitivity of 0.78 and specificity of 1.00. Although registry-based estimates underestimated absolute values, they closely tracked temporal prescribing patterns. Calibration substantially improved agreement with manually classified outcomes.
CONCLUSIONS: The GR captured clinically meaningful prescribing patterns and may support scalable monitoring of post-diagnostic antibiotic decision-making in stewardship programmes.
PMID:42682393 | PMC:PMC13529414 | DOI:10.1093/jacamr/dlag195
