Similarities and differences in antimicrobial prescribing between major city hospitals and regional and remote hospitals in Australia

doi:10.1016/j.ijantimicag.2018.10.009

International Journal of Antimicrobial Agents

Volume 53, Issue 2, February 2019, Pages 171-176

https://doi.org/10.1016/j.ijantimicag.2018.10.009 Get rights and content

ABSTRACT

Many regional and remote hospitals (RRHs) do not have the specialist services that usually support antimicrobial stewardship (AMS) programmes in major city hospitals. It is not known if this is associated with higher rates of inappropriate antimicrobial prescribing. The aim of this study was to identify similarities and differences in antimicrobial prescribing patterns between major city hospitals and RRHs in Australia. The Australian Hospital National Antimicrobial Prescribing Survey (H-NAPS) datasets from 2014, 2015 and 2016 (totalling 47,876 antimicrobial prescriptions) were analysed. The antimicrobial prescribed, indications for use, documentation of indication, recording of a review date and assessment of the appropriateness of prescribing were evaluated. Overall, inappropriate prescribing of antimicrobials was higher in RRHs than in major city hospitals (24.0% vs. 22.1%; P<0.001). Compared with major city hospitals, inappropriate prescribing of ceftriaxone was higher in RRHs (33.9% vs. 27.6%; P<0.001), as was inappropriate prescribing for cellulitis (25.7% vs. 19.0%; P≤0.001). A higher rate of inappropriate prescribing was noted for some high-risk infections in RRHs compared with major city hospitals, including Gram-positive bacteraemia with sepsis (12.6% vs. 6.5%; P=0.004), empiric therapy for sepsis (26.0% vs. 12.0%; P<0.001) and endocarditis (8.2% vs. 2.7%; P=0.02). To the authors’ knowledge, this is the largest study to date comparing antimicrobial prescribing of RRHs with major city hospitals. A key finding was that antimicrobial prescribing was more frequently inappropriate for some high-risk infections treated in RRHs. Targeted strategies that support appropriate antimicrobial prescribing in RRHs are required.

Introduction

Many regional and remote hospitals (RRHs) do not have the specialist resources that usually support antimicrobial stewardship (AMS) programmes in major city hospitals [1]. Studies from a number of countries have highlighted that the uptake of AMS activities in RRHs is more limited compared with major city hospitals [1], [2], [3], [4], [5], and that RRHs face unique challenges in delivering AMS programmes [6], [7]. It is not known if this is associated with higher rates of inappropriate antimicrobial prescribing. The lack of information on antimicrobial prescribing practices in RRHs limits the development of tailored AMS interventions.

The aim of this study was to identify similarities and differences in antimicrobial prescribing patterns between major city hospitals and RRH in Australia using data submitted through the Hospital National Antimicrobial Prescribing Survey (H-NAPS).

Section snippets

Materials and methods

H-NAPS is a standardized antimicrobial prescribing point prevalence auditing programme. Hospital-based auditors capture patient-specific information such as demographics, antimicrobial drugs prescribed, allergies, renal impairment and other clinical comorbidities, indication for antimicrobial use, documentation of the intended duration of antimicrobial therapy and microbiology results. The local hospital's nominated assessor determines the appropriateness of each antimicrobial prescription. An

Results

In total, 47 876 antimicrobial prescriptions were included in the analysis, comprising 31 579 (65.96%) from major city hospitals, 9652 (20.16%) from inner regional hospitals, 5035 (10.52%) from outer regional hospitals, 1088 (2.27%) from remote hospitals and 522 (1.09%) from very remote hospitals. In total, RRHs contributed 16 297 (34.04%) antimicrobial prescriptions.

Discussion

This study comparing antimicrobial prescribing patterns of RRHs with major city hospitals has provided valuable insights that will guide AMS initiatives targeted at RRHs. Of concern is the finding that prescribing of antimicrobials for some high-risk infections outside of major city hospitals is frequently inappropriate. Timely treatment with appropriate antimicrobials is important to reduce morbidity and mortality from high-risk infections, such as sepsis [10]. High-risk infection management

Conclusion

This study provided valuable insight into the similarities and differences in antimicrobial prescribing between RRHs and major city hospitals. High-risk infections are being managed in RRHs, and the appropriateness of antimicrobial prescribing for some of these high-risk infections is lower than in major city hospitals. The management of cellulitis and the use of ceftriaxone were also identified as areas for improvement in RRHs. These findings will assist the tailoring of AMS initiatives to

Acknowledgements

The authors wish to thank the H-NAPS team for their coordination and management of the NAPS audits and release of the data from the portal. Since 2013, the Australian Commission on Safety and Quality in Heath Care (ACSQHC) has provided a funding contribution for the development of the NAPS programme for the Antimicrobial Use and Resistance in Australia Surveillance System. The ACSQHC is jointly funded by all Australian state and territory governments.

Declarations

Funding

This work was supported by a National

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Short CommunicationSimilarities and differences in antimicrobial prescribing between major city hospitals and regional and remote hospitals in Australia

ABSTRACT

Introduction

Section snippets

Materials and methods

Results

Discussion

Conclusion

Acknowledgements

Declarations

Funding

Am J Infect Control

Health Place

Lancet Infect Dis

Infect Dis Clin N Am

Infect Dis Health

A mixed methods study of the barriers and enablers in implementing antimicrobial stewardship programmes in Australian regional and rural hospitals

J Antimicrob Chemother

Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps

Med J Aust

Antibiotic stewardship programs in U.S. acute care hospitals: findings from the 2014 National Healthcare Safety Network (NHSN) annual hospital survey

Clin Infect Dis

Short Communication
Similarities and differences in antimicrobial prescribing between major city hospitals and regional and remote hospitals in Australia