Appropriateness of acute-care antibiotic prescriptions for community-acquired infections and surgical antibiotic prophylaxis in England: analysis of 2016 national point prevalence survey data.

Abstract

BACKGROUND:

Estimates of inappropriate prescribing can highlight key target areas for antimicrobial stewardship (AMS) and inform national targets.

OBJECTIVES:

To (1) define and (2) produce estimates of inappropriate antibiotic prescribing levels within acute hospital trusts in England.

METHODS:

The 2016 national Healthcare-Associated Infections (HAI), Antimicrobial Use (AMU) and AMS point prevalence survey (PPS) was used to derive estimates of inappropriate prescribing, focusing on the four most reported community-acquired antibiotic indications (CAIs) in the PPS and surgical prophylaxis. Definitions of appropriate antibiotic therapy for each indication were developed through the compilation of national treatment guidelines. A Likert-scale system of appropriateness coding was validated and refined through a two-stage expert review process.

RESULTS:

Antimicrobial usage prevalence data were collected for 25,741 individual antibiotic prescriptions, representing 17,884 patients and 213 hospitals in England. 30.4% of prescriptions for the four CAIs of interest were estimated to be inappropriate (2054 prescriptions). The highest percentage of inappropriate prescribing occurred in uncomplicated cystitis prescriptions (62.5%), followed by bronchitis (48%). For surgical prophylaxis, 30.8% of prescriptions were inappropriate in terms of dose number, and 21.3% in terms of excess prophylaxis duration.

CONCLUSIONS:

The 2016 prevalence of inappropriate antibiotic prescribing in hospitals in England was approximated to be 30.4%; this establishes a baseline prevalence and provided indication of where AMS interventions should be prioritized. Our definitions appraised antibiotic choice, treatment duration and dose number (surgical prophylaxis only); however, they did not consider other aspects of appropriateness, such as combination therapy - this is an important area for future work.

• Authors: H Higgins, R Freeman, A Doble, G Hood, J Islam, S Gerver, K L Henderson, A Demirjian, S Hopkins, D Ashiru-Oredope
• Journal: The Journal of hospital infection (J Hosp Infect) Vol. 142 Pg. 115-129 (Dec 2023) ISSN: 1532-2939 [Electronic] England
• PMID: 37858806 (Publication Type: Journal Article)
• Copyright: Crown Copyright © 2023. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Anti-Infective Agents

Topics

• Humans
• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Prevalence
• Community-Acquired Infections (drug therapy, prevention & control)
• Anti-Infective Agents (therapeutic use)
• Prescriptions
• England (epidemiology)
• Drug Prescriptions