Appropriateness of antibiotic use in community hospitals in rural Newfoundland and Labrador

Surveillance of the appropriateness of antimicrobial prescribing can identify targets for quality improvement in antimicrobial stewardship. Our objective was to measure antibiotic prescription prevalence, indication, and appropriateness at three rural community hospitals in a 1-day point prevalence study.

Inpatient antibiotic prescriptions given at three community hospitals on April 24, 2019 were provided by the hospital pharmacies. These prescriptions were analyzed using the Australian National Antimicrobial Prescribing Survey (NAPS) tool. Prescriptions were assessed by an infectious diseases physician and analyzed per prescription.

Eighty prescriptions given to 58 inpatients were included. Antibiotic treatment prevalence was 58/120 beds (48.3%), and overall appropriateness was 37/80 prescriptions (46.3%). The most prescribed antibiotics were ceftriaxone (17 [21.3%]; 47.1% appropriate), piperacillin-tazobactam (10 [12.5%]; 10.0% appropriate), and moxifloxacin (9 [11.3%]; 0% appropriate). The most common indications were respiratory tract infections (36 [45.0%]; 36.1% appropriate), skin and soft tissue infections (14 [17.5%]; 78.6% appropriate), and urinary tract infections (9 [11.3%]; 11.1% appropriate). Of the 80 prescriptions, 50 (62.5%) documented an indication, and 71 (88.8%) documented a stop or review date.

We observed a high treatment prevalence and low appropriateness. Overall appropriateness was lower than in urban hospitals.