Reducing inappropriate third-generation cephalosporin use for community-acquired pneumonia in a small Australian emergency department.

Background: Antimicrobial stewardship is a key component of hospital accreditation in Australia and contributes to the prevention and containment of antimicrobial resistance. The Second Australian Report on Antimicrobial Use and Resistance in Human Health (AURA Report) 2017 calls for greater participation by small hospitals in antimicrobial stewardship activities. Community acquired pneumonia (CAP) and third generation cephalosporin (3GCs) use is a known target for intervention. This paper reports the results of an educational intervention for reducing inappropriate prescribing of 3GCs in the empiric treatment of CAP.

Methods: The intervention was based on a leadership and education campaign in an Emergency Department (ED) in a 96 bed acute rural hospital in New South Wales, Australia. A two-point retrospective audit within (April-June 2010, April-June 2011) was conducted comparing pre-intervention and post-intervention antibiotic prescribing trends for CAP from ED presentations. Data was collected via audit tool and appropriateness was assessed against endorsed guidelines. The main outcome measures were improved prescribing appropriateness and decreased utilisation.

Results: Whilst statistically insignificant, a reduction (6.4%) in inappropriate prescribing and a reduction in 3GC utilisation (16.7%) was demonstrated.

Conclusion: Small hospitals have active contributions to make to prevent and contain antimicrobial resistance via antimicrobial stewardship. The challenge is collecting this data for national data sets whilst instituting local benefits in the context of limited resources. Our results suggest change can occur in antibiotic prescribing, studies such as this model a targeted strategy for resource poor facilities to contribute to national AU data whilst instituting local AMS change.