Identifying targets for quality improvement in hospital antibiotic prescribing.

Objectives: To audit antibiotic use in a university hospital and to identify targets for quality improvement in a setting with low antibiotic use and resistance rates.

Methodology: A point-prevalence survey (PPS), using a patient-based audit tool for antibiotic use, was executed in the Radboud University Medical Centre in May 2013. On one index day, all patients on systemic antibiotics hospitalised > 24 hours were included. Data regarding antibiotic prescriptions were extracted from the medical records. Multiple logistic regression analysis was performed in order to predict whether a variable was associated with low guideline compliance or a low rate of consulting an infectious disease specialist.

Results: 428 hospitalised patients were included, of whom 40.9% received antibiotics. Overall, 75.7% of all prescriptions were compliant with the guidelines in place and for 87.8% the reason for prescription was documented. Amoxicillin/clavulanic acid (OR = 4.08, 95% CI 1.57-10.56), and respiratory tract infections (RTI) (OR = 6.17, 95% CI 2.55-14.94) were associated with low compliance with guidelines. An infectious disease physician or medical microbiologist was less often consulted for empirical therapy (OR 23.21, 95% CI 6.37-84.51) or empirical therapy continued > 72 hours (OR 14.69, 95% CI 3.56-60.56) compared with prescriptions that were based on culture results. In addition, fewer consultations were requested for RTI (OR 4.47, 95% CI 1.39-14.35).

Conclusion: A PPS is a good tool to identify targets for antibiotic stewardship in routine clinical practice. Several areas for improvement, such as a low compliance with guidelines for amoxicillin/clavulanic acid and RTI, and a low rate of consulting an infectious disease physician or medical microbiologist concerning antibiotic therapy in case of RTI and empirical therapy continued > 72 hours were identified.