Cultivating global antimicrobial stewardship: prescribing quality and implementability insights from Portugal's First...

Assessing the quality of antimicrobial prescribing is critical to combating antimicrobial resistance. The Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) assists in the assessment of antimicrobial prescribing appropriateness using consensus definitions, extending beyond guidelines compliance. Applying the Hospital NAPS in Portugal can address a knowledge gap.

To assess the quality of antibiotic prescribing in a sample of Portuguese hospitals and evaluate Hospital NAPS implementability.

A point prevalence audit using the translated and culturally validated Hospital NAPS definitions for Portugal and Hospital NAPS methodology was conducted across eight Portuguese hospitals from October 2023 to February 2024. Antimicrobial stewardship teams were surveyed to explore implementability.

Among 2178 non-critical adult inpatients, 719 (33%) received antibiotics, resulting in 881 prescriptions (1.2 per patient). Most were male (68%), with a median age of 74 years, admitted to medical wards (46%) and managed by internal medicine (39%). Treatment indications accounted for 86% of prescriptions. High documentation rates were observed for indication (95%) and review/stop dates (91%). Guideline compliance was 68% Unnecessary prescribing occurred in 7%. Overall prescriptions inappropriateness was 42%. Spectrum too broad (41%) or incorrect dose or frequency (29%) were the main reasons for prescriptions being deemed inappropriate. Surgical prophylaxis > 24 h occurred in 26% of surgeries. Participants reported that Hospital NAPS has potential for implementation in Portugal.

The First Portugal Hospital NAPS increased knowledge about antibiotic prescribing, identified areas for improvement and demonstrated the potential for Hospital NAPS implementation in Portugal, contributing to global antimicrobial stewardship efforts.