Abstract
The objectives of the present study were to provide a snapshot analysis of antibiotic appropriateness in two hospitals in Southern Italy in three specific areas, surgical, medical and intensive care, and to evaluate the risk factors associated with inappropriateness in antimicrobial prescriptions. We conducted a multicentre observational study in two hospitals in the Campania region. We collected data of all patients admitted on the day of evaluation to antibiotic therapy or prophylaxis through a case report form. The primary outcome was to assess the inappropriateness of antibiotic prescribing, related to the spectrum, dose, route of administration and duration of treatment—in particular, to assess whether there was a difference in the adequacy of the prescriptive practice in the medical, surgical and intensive sectors. Prescriptive inappropriateness was more frequently observed in surgical units (79.8% of the 104 antimicrobial prescriptions) than in medical units (53.8% of the 65 prescriptions, p = 0.0003) or in intensive care units (64.1% of the 39 prescriptions, p = 0.052). The reasons for the inappropriate antimicrobial prescriptions were similar in the three areas evaluated: antimicrobial unnecessary and antimicrobial not recommended were the most frequent reasons for inappropriateness. Not participating in an antimicrobial stewardship program (ASP) was identified as a factor associated with inappropriate antimicrobial prescriptions in medical and surgical units, but not in Intensive Care Units (ICUs). ASPs may enhance the appropriateness of antimicrobial prescriptions especially in medical and surgical units. In ICUs, specific programs able to limit empirical therapies and encourage the collection of microbiological samples may be useful to set up targeted therapies and to design antimicrobial protocols.
Highlights
This article is an open access articleAntibiotic resistance is a major public health problem and antimicrobial overuse is considered the principal driver in selecting for antimicrobial-resistant organisms, with a strong association between the rising rates of use and increasing rates of antimicrobialresistant organisms [1,2]
The objectives of the present study were to provide a snapshot analysis of antibiotic appropriateness in two hospitals in Southern Italy in three specific areas, surgical, medical and intensive care, including both adult and paediatric patients, and to evaluate the risk factors associated with inappropriateness in antimicrobial prescriptions, such as the absence of an antimicrobial stewardship program in the unit
Prescriptive inappropriateness was more frequently observed in surgical units (79.8% of the 104 antimicrobial prescriptions) than in medical units (53.8% of the 65 prescriptions, odds ratios (OR) 3.39, 95% CI 1.71–6.71, p = 0.0003) and Intensive Care Units (ICUs)
Summary
Antibiotic resistance is a major public health problem and antimicrobial overuse is considered the principal driver in selecting for antimicrobial-resistant organisms, with a strong association between the rising rates of use and increasing rates of antimicrobialresistant organisms [1,2]. It is important to reduce the inappropriate use of antibiotic therapy [3]. That the definition of inappropriateness could vary according to the setting and is not always clear-cut. Improving antibiotic prescriptions in the hospital setting is of the utmost importance to preserve their effectiveness. Knowing the degree of inappropriateness in antimicrobial prescriptions and the factors associated may be useful in the design of strategies to reduce the development of multidrug-resistant microorganisms
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