Abstract
BackgroundUnnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9–64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription.Methodology/Principal FindingsExperienced infectious diseases (ID) fellows performed audits of antimicrobial use at regular intervals among all patients—with or without antimicrobials—hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist.We evaluated 1577 patients of whom 700 (44.4%) had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4%) prescriptions were for therapy and 312 (24.6%) for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%); incorrect choice of antimicrobials (7.6%); incorrect application of drugs (9.3%); and divergence from institutional guidelines (8%). Characteristics of inappropriate prophylaxes were: No indication (9%); incorrect choice of antimicrobials (1%); duration too long or other inappropriate use (6.7%). Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results.Conclusions/SignificanceAudits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial prescriptions without indication, and divergence from institutional guidelines were frequent errors. Based on these results, we will tailor education, amend institutional guidelines and further develop the infectious diseases consultation service.
Highlights
Antimicrobial therapy and prophylaxis in hospitals has been reported to be incorrect or not indicated in 9 to 64% [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]
Surveys of local prescribing practice among physicians working in different fields of medicine and in different hospital units may be a source for improving local institutional guidelines and tailoring interventions to foster rational and responsible antimicrobial use
We studied the quality of antimicrobial therapy and prophylaxis among individual patients hospitalised at a tertiary care university hospital in Switzerland by repeated prevalence survey in surgical, medical and haemato-oncology wards, and in surgical and medical intensive care units (ICUs)
Summary
Antimicrobial therapy and prophylaxis in hospitals has been reported to be incorrect or not indicated in 9 to 64% [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] (table S1). Antimicrobial stewardship programmes aim to reduce and optimize antimicrobial use in order to prevent the emergence of resistance or other adverse effects, improve outcome of care, and reduce health care costs without compromising quality of care [24]. Methods of such programmes include: Quantitative monitoring of antimicrobial use in hospitals or hospital units; qualitative evaluation of antimicrobial treatment and prophylaxis in individual patients; monitoring of local antimicrobial susceptibility; promotion of institutional guidelines; and education [24,25,26,27]. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
