ArticleFrontiers in cellular and infection microbiology2026
Development and applicability assessment of a 5R-principle-guided evaluation system for antimicrobial stewardship in open extremity trauma using a hybrid Delphi-analytic hierarchy process model.
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Open extremity trauma is associated with a high risk of infection, making appropriate antimicrobial use essential. However, existing stewardship tools are often generic and lack a structured, hierarchical evaluation system tailored to this setting. Methods: We developed an initial indicator set based on the 5R principles (Right Patient, Right Drug, Right Dose, Right Time, and Right Route). A national panel of 42 experts participated in two rounds of a modified Delphi survey using a 5-point Likert scale to rate indicator importance. The analytic hierarchy process (AHP) was used to assign indicator weights. The finalized system was preliminarily assessed in a retrospective cohort from the Hand and Foot Surgery Department at the Lequn Campus, First Hospital of Jilin University, comparing a pharmacist-led intervention group with a routine-care control group. Results: Response rates were 100% in both Delphi rounds, and the expert authority coefficient was 0.87. Across the two rounds, Kendall's W values ranged from 0.044 to 0.110 for secondary and tertiary indicators, with all P < 0.05, demonstrating statistically significant expert agreement. All indicators met predefined consensus criteria (mean score ≥ 4.0; coefficient of variation ≤ 0.25). The final system comprised 5 primary, 11 secondary, and 22 tertiary indicators; all AHP consistency ratios were < 0.1. In the preliminary applicability assessment, the intervention group achieved higher appropriateness scores (P=0.004) and lower total antimicrobial costs (P<0.001) than the control group. Conclusion: A 5R-guided, Delphi-AHP-derived evaluation system was developed and preliminarily validated. The tool can support standardized assessment and targeted pharmacist-led antimicrobial stewardship in open extremity trauma.
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