Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025
Antimicrobial prescribing quality in Australian emergency departments: an analysis of the Hospital NAPS data set.
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Zosky-Shiller Lenna, Thursky Karin, Park Sarah, James Rodney, Hall Lisa, Chen Caroline, Ierano Courtney
Аннотация
OBJECTIVE: To analyze antimicrobial prescribing practices in Australian emergency departments (ED), identifying prescribing areas requiring improvement. This aims to inform antimicrobial stewardship (AMS) strategies to enhance antimicrobial prescribing quality.
DESIGN: Retrospective analysis of the Hospital National Antimicrobial Prescribing Survey (NAPS) data set.
SETTING: EDs in public and private Australian hospitals (n = 652).
PARTICIPANTS: Hospitals (n = 652) that participated in the Hospital NAPS from 2013 to 2022.
METHODS: Data were collected by trained auditors from participating hospitals with the use of a standardized auditing tool, the Hospital NAPS. Data from 2013 to 2022 were analyzed descriptively. Variables assessed included guideline compliance and appropriateness by antimicrobial and indication, and reasons for inappropriateness.
RESULTS: There were 3,098 antimicrobial prescriptions from EDs included for analysis. Guideline compliance (63.5%) and appropriateness (70.4%) in EDs were lower compared to overall prescribing practices from all departments. The most commonly prescribed antimicrobial was ceftriaxone (16.9%, n = 523), and the most common indication was empiric prescribing for community-acquired pneumonia (16.0%, n = 497). Amoxicillin-clavulanic acid (53.2%, n = 99), and acute exacerbation of chronic obstructive pulmonary disease (54.3%, n = 57), were the antimicrobial and indication with the lowest rates of appropriateness respectively. Ceftriaxone prescribing also had a low rate of appropriateness (62.3%, n = 326). Selection of antimicrobials with too broad of a spectrum was the most common reason for inappropriateness (40.2%).
CONCLUSION: Antimicrobial prescribing quality in EDs warrants improvement. Recommended targets for AMS interventions are the excessive and inappropriate use of broad-spectrum antimicrobials such as ceftriaxone and amoxicillin-clavulanic acid in common respiratory and urinary tract infections.
DESIGN: Retrospective analysis of the Hospital National Antimicrobial Prescribing Survey (NAPS) data set.
SETTING: EDs in public and private Australian hospitals (n = 652).
PARTICIPANTS: Hospitals (n = 652) that participated in the Hospital NAPS from 2013 to 2022.
METHODS: Data were collected by trained auditors from participating hospitals with the use of a standardized auditing tool, the Hospital NAPS. Data from 2013 to 2022 were analyzed descriptively. Variables assessed included guideline compliance and appropriateness by antimicrobial and indication, and reasons for inappropriateness.
RESULTS: There were 3,098 antimicrobial prescriptions from EDs included for analysis. Guideline compliance (63.5%) and appropriateness (70.4%) in EDs were lower compared to overall prescribing practices from all departments. The most commonly prescribed antimicrobial was ceftriaxone (16.9%, n = 523), and the most common indication was empiric prescribing for community-acquired pneumonia (16.0%, n = 497). Amoxicillin-clavulanic acid (53.2%, n = 99), and acute exacerbation of chronic obstructive pulmonary disease (54.3%, n = 57), were the antimicrobial and indication with the lowest rates of appropriateness respectively. Ceftriaxone prescribing also had a low rate of appropriateness (62.3%, n = 326). Selection of antimicrobials with too broad of a spectrum was the most common reason for inappropriateness (40.2%).
CONCLUSION: Antimicrobial prescribing quality in EDs warrants improvement. Recommended targets for AMS interventions are the excessive and inappropriate use of broad-spectrum antimicrobials such as ceftriaxone and amoxicillin-clavulanic acid in common respiratory and urinary tract infections.