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Antimicrobial stewardship practice in New Zealand's rural hospitals
Jared Green1, Sharon J Gardiner2, Sarah L Clarke3
1Infectious Diseases Department, Christchurch Hospital, Department of Rural Hospital Medicine, Kaitaia Hospital, Kaitaia.
Aims:
We aimed to describe how antimicrobial stewardship (AMS) is practised in New Zealand's diverse rural hospital network.
Methods:
Rural hospital medical practitioners were surveyed to estimate the utilisation of prescribing resources and specialist support for AMS, and attitudes towards AMS. Questions reflected recommended strategies for AMS programmes.
Results:
The response rate was 80.8% (122/151) from 29 rural hospitals (3-114 beds). While 78.7% reported access to local antimicrobial prescribing guidelines, discordant answers from practitioners at the same institution were common. The practice of approval for access to broad-spectrum antimicrobial agents was uncommon. Most respondents had cared for a patient with a multi-drug resistant organism in the preceding 12 months. Only 34.8% of respondents reported receiving formal education on AMS principles, with at least 90% believing it was relevant irrespective of the clinical context considered. Respondents were more likely to believe that antimicrobial overuse and resistance were more relevant at sites distant from the context of rural hospital practice.
Conclusion:
While AMS is perceived as relevant for rural hospital medicine, many of the building blocks of AMS systems are absent in this environment. This presents an opportunity for development as AMS strategies evolve in New Zealand.