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An audit of antibiotic prescriptions: an antimicrobial stewardship pre-implementation study at a tertiary care public
Jowhara Cassim1, Sabiha Y Essack1,2, Sarentha Chetty1
1Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa.
Insights
This audit revealed significant issues in antibiotic prescribing at a public hospital, with two-thirds of prescriptions not meeting key process measures. These findings underscore the need for antimicrobial stewardship programs to improve antibiotic use.
Area of Science:
- Medical Sciences
- Clinical Pharmacy
- Infectious Diseases
Background:
- Antimicrobial resistance is a growing global health threat.
- Appropriate antibiotic prescribing is crucial for patient outcomes and resistance containment.
- Tertiary-level hospitals require robust antimicrobial stewardship programs.
Purpose of the Study:
- To audit antibiotic prescribing practices at a tertiary-level public hospital.
- To identify areas for improvement prior to implementing an antimicrobial stewardship program.
Main Methods:
- Retrospective audit of 380 patient medical charts from April to June 2020.
- Evaluation of process measures including pre-prescription cultures, therapy duration, de-escalation, and concurrent antibiotic use.
- Statistical analysis using Stata (Version 17).
Main Results:
- Two-thirds of antibiotic prescriptions showed non-compliance with at least one process measure.
- Excessive duration of therapy (3.16%), lack of de-escalation (4.74%), and limited parenteral-to-oral switch (3.16%) were observed.
- Redundant antibiotic coverage (36.05%) and non-adherence to susceptibility results (25.79%) were also noted.
Conclusions:
- Inappropriate antibiotic prescribing was identified in the audited population.
- The study highlights the necessity of implementing antimicrobial stewardship interventions.
- Process and outcome measures are essential for effective antimicrobial stewardship.
Objective:
To audit the prescribing of antibiotics at a tertiary-level public hospital, in preparation for the implementation of an antimicrobial stewardship programme.
Methods:
A retrospective audit of antibiotic prescriptions for the period April 2020 to June 2020 was conducted to ascertain appropriate antibiotic prescribing based on a set of process measures, which included whether cultures were taken before the initiation of empirical antibiotics, the duration of antibiotic therapy, de-escalation to a narrower spectrum antibiotic, the concurrent use of four or more antibiotics, documented indication for antibiotic use, and parenteral to oral conversion. Statistics were calculated using Stata (Version 17).
Results:
A total of 380 patient medical charts were reviewed. It was noted that there were no standalone antibiotic charts, and antibiotics were prescribed alongside other medication in one prescription record. There was non-compliance to one or more of the process measures in two-thirds of antibiotic prescriptions audited. Excessive duration of therapy was evident in 3.16% (12) prescriptions. There were 18 (4.74%) instances in which de-escalation to a narrower spectrum antibiotic based on susceptibility results did not occur. Only a small proportion of patients were switched from parenteral to oral antibiotics (n = 12, 3.16%). Some of the additional findings included redundant antibiotic coverage (n = 137, 36.05%) and prescription of an antibiotic that did not align with the susceptibility results (n = 98, 25.79%).
Conclusions:
Inappropriate antibiotic prescribing did occur in some cases. The results from this pre-implementation study highlight the importance of introducing antimicrobial stewardship interventions with process and outcome measures.
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