Appropriateness of antimicrobial therapy measured by repeated prevalence surveys

Prudent use of antibiotics is mandatory to control antibiotic resistance. The objective of this study was to determine if prevalence surveys are useful tools to determine the appropriateness of antimicrobial therapy (AMT) and determinants of inappropriate AMT. The study was performed in a 1,350-bed teaching hospital including all medical specialties. Six consecutive 1-day prevalence surveys of in-patients were performed twice yearly from 2001 to 2004. Data on the demographics, infections, and AMT were gathered. The appropriateness of AMT was assessed according to a standardized algorithm based on the local AMT prescription guidelines. On average, 684 patients were included in each survey (total, 4,105). The use of AMT as determined in the prevalence survey corresponded to the annual data from the pharmacy department. Nine hundred thirty-eight (22.9%) of the patients received AMT, and in 351 (37.4%) of these patients AMT was inappropriate. Only 25 (0.6%) patients did not receive AMT, although it was indicated. After multivariate analysis, the use of quinolones was the only statistically significant variable associated with inappropriate use. Prevalence surveys proved to be useful tools to judge the appropriateness of AMT and to identify determinants of inappropriate use. This study shows that in a setting with a low use of AMT, there are few patients who inadvertently do not receive AMT. On the other hand, a substantial number of the patients are treated inappropriate.