Appropriateness of antimicrobial prescribing in a Swiss tertiary care hospital: a repeated point prevalence survey

Abstract

AIMS OF THE STUDY: Inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance and adverse events. Antimicrobial stewardship programmes may both optimise treatment of infections and reduce antimicrobial resistance but are implemented in only a minority of Swiss hospitals. In addition, data on prescribing patterns and quality are scarce. We conducted a repeated point prevalence survey to evaluate the quality of antimicrobial prescribing in a single tertiary care centre. METHODS: Antimicrobial use was audited twice (summer 2017 and winter 2018) among all patients admitted to the University Hospital Basel, Switzerland. Data were collected from the electronic health record. Appropriateness of antimicrobial use was evaluated according to previously published rules and local national guidelines. RESULTS: We evaluated 1112 patients of whom 378 (34%) received 548 prescriptions in total (30% for prophylaxis). Penicillins with β-lactamase inhibitors were most commonly used (30%), followed by cotrimoxazole (12%) and ceftriaxone (7%). Intravenous administration was chosen in 56% of patients. Prior to antimicrobial therapy, blood cultures were collected in 69% of patients. Overall, 182 (33%) prescriptions were not appropriate; reasons included lack of indication (11%), incorrect dosing (7%), delay in intravenous to oral switch (9%) or non-adherence to local guidelines (15%). A minority of patients received antimicrobials despite documented allergies (2%). Almost 38% of empirical prescriptions were inappropriate, compared with only 19% of prophylactic and 20% of targeted prescriptions. Penicillins with β-lactamase inhibitors and cephalosporins were most commonly involved in inappropriate prescribing (>50%) followed by carbapenems (30%), narrow-spectrum penicillins (17%) and cotrimoxazole (6%), with oral administration being involved less frequently than intravenous administration (15 vs 37%). Infectious diseases consultation and presence of immunosuppression were associated with reduced odds (odds ra-tio [OR] 0.38, 95% confidence interval [CI] 0.21-0.70 and OR 0.31, 95% CI 0.17-0.54, respectively) of inappropriate prescription in the per-patient multivariable analysis, whereas being admitted to a surgical or intensive care unit was associated with increased odds (OR 1.83 and 5.67) compared with a medical unit. CONCLUSION: Almost one third of prescriptions were inappropriate in our tertiary care centre despite local guidelines and an on-demand infectious diseases consultation service. Our results underscore the need for expanding current antimicrobial stewardship efforts, including national initiatives such as stewardship and prescribing guidelines, repeated surveys and identification of areas for improvement including timely intravenous to oral switches in order to reduce the consequences of inappropriate prescribing and of multidrug resistant organisms.

Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study

“…Antimicrobials are commonly used in the acute care setting. Recent studies found that approximately 30% of patients received antimicrobials during hospitalization [ 1 , 2 ], and 33% of antimicrobial prescriptions were considered inappropriate [ 3 ]. A multicenter study in Japan revealed an inappropriate antimicrobial use rate of approximately 40% for the inpatient population at acute care hospitals [ 4 ].…”

Review of the Appropriateness of Surgical Antimicrobial Prophylaxis

“…As well, Muhammed et al stated that about half (49.3%) of noncompliance to the guidelines in their study was found from surgical and gynecologic/obstetrics wards due to either longer duration of therapy or wrong timing ceftriaxone use in surgical prophylaxis [66]. Gürtler et al stated that 19.9% of all prophylactic prescriptions in a Swiss tertiary care hospital violated one or more appropriateness criteria, of which 40% concerned with extended postoperative surgical prophylaxis [67]. Komagamine et al stated that more than twothirds of the antimicrobial drugs used for surgical prophylaxis were administered for durations longer than 1 day, whereas the duration of antimicrobial drugs for surgical prophylaxis of 1 day or less has been found to be sufficient in most cases [68].…”

Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

“…A multivariate logistic regression model was performed to adjust the effects of potential factors that were significant in simple logistic regression ( p < 0.05). The selection of variables was based on biological plausibility and demonstrated association in other previous literature [ 39 ]. The percentage of agreement and Kappa coefficient were used to investigate an agreement between pathogen-directed therapy prescribed and AST results.…”