Individual Patient-by-Patient Surveillance of the Antimicrobial Usage among Inpatients in Kanazawa University Hospital.

Abstract

To explore appropriate antimicrobial usage in Kanazawa University Hospital, the surveillance of antimicrobial use on an individual patient basis was conducted and analyses of outstanding cases were made in detail. All data of inpatients between August 1st and November 30th 1999, who were prescribed at least one of the 11 antimicrobial injections that are frequently used at our hospital were collected by utilizing a computer database support system of the hospital. The overall usage seemed appropriate in terms of the period of use based on an antimicrobial analysis. However, an analysis on an individual-patient basis suggested some inappropriate usage/misuse in certain cases. Imipenem was prescribed from the ophthalmology ward in more than 50% of all cases. This was found to be used as a postoperative prophylactic antibiotic. Since no antibiotic was prescribed to these patients thereafter, this usage cannot be defined as inappropriate although alternative antibiotics may be considered. Vancomycin was prescribed to some methicillin-resistant Staphylococcus aureus-negative patients. We also found some extensively prolonged usage of antimicrobials. All of these were considered to be inappropriate in regard to usage specified for insurance. After investigations of medical charts and consultations with attending physicians, these antimicorobials had been empirically prescribed. In one case, imipenem was prescribed to an imipenem-insensitive patient. A different effective antimicrobial drug should have been prescribed. In conclusion, we were able to uncover some inappropriate usage of antimicrobials in a patient-by-patient investigation. Our findings suggest that further surveillance and on-time suggestions to prescribers should result in a more appropriate administration of antimicrobials.