The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-07-18 DOI:10.1016/j.jhin.2024.06.016

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Abstract

Background

Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice.

Methods

A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013–2022) and surgical site infection data from Surgical NAPS (2016–2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness.

Results

From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350).

Conclusions

As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.

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澳大利亚医院皮肤和软组织管理中抗菌药物处方的质量：全国抗菌药物处方调查数据分析。

背景：皮肤和软组织感染（SSTI）是医院开具抗菌药处方最常见的适应症之一。抗菌药使用不当会导致发病率上升、不必要的再次入院和抗菌药耐药性增加。本研究旨在评估澳大利亚医院在处理 SSTI 时抗菌药物处方的质量，为今后的实践提供指导：方法：利用全国抗菌药物处方调查（NAPS）的数据进行回顾性分析。分析了来自医院 NAPS（2013-2022 年）的 SSTI 处方数据和来自外科 NAPS（2016-2022 年）数据集的手术部位感染数据。评估变量包括指南合规性、NAPS结构化算法的适宜性以及不适宜的原因：从医院 NAPS 数据集中分析了 40,535 个 SSTI 抗菌药物处方。最常见的适应症是蜂窝组织炎（34.1%；n=13,822），处方最多的抗菌药物是氟氯西林（18.8%；n=7,638）。与所有其他抗菌药物处方适应症相比，SSTI 适应症的指南符合率较低，但适当率较高（指南符合率为 66.3%，n=21,035 vs 67.4%，n=156,285 适当率为 75.6%，n=30,639 vs 72.7%，n=209,383）。不适当的最常见原因是剂量或频率不正确（29.3%；n=2,367）。从外科 NAPS 数据集中，分析了 5,674 个手术部位感染的处方。68.2%（n=3867）的处方被认为是适当的。不适当的最常见原因是剂量或频率不正确（27.7%；n=350）：由于SSTI是澳大利亚医院开具抗菌药物处方的常见指征，因此建议确定有效的抗菌药物管理策略，以优化SSTI管理中抗菌药物的使用，从而改善患者的治疗效果。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.