Similarities and differences in antimicrobial prescribing between Australian major-city hospitals and, regional and remote hospitals.

Abstract

Background

Many regional and remote hospitals are without specialist services that usually support Antimicrobial Stewardship (AMS) programs in major-city hospitals. Whether this is associated with higher rates of inappropriate antimicrobial prescribing is unknown.

Objectives/Aims

The aim of this study was to determine if there are similarities and differences in antimicrobial prescribing between Australian major-city hospitals and Australian regional and remote hospitals.

Method

Data from the 2014, 2015 and 2016 hospital National Antimicrobial Prescribing Survey (NAPS) was analysed in two groups based on Australian Statistical Geography Standard Remoteness Area classifications; major-city and RRH (incorporating inner regional, outer regional, remote and very remote). The antimicrobial prescribed, indications for use, documentation of indication, recording of a review date and the assessment of the appropriateness of prescribing were evaluated. Pearson chi-square test (χ2 tests) were performed to detect any differences between the two groups.

Results

47,876 antimicrobial prescriptions were analysed. Overall, inappropriate prescribing of antimicrobials was higher in RRH than in major-city hospitals (24.0% v 22.1%, p<0.001). Compared to major-city hospitals, inappropriate prescribing of ceftriaxone was higher in RRH (33.9% v 27.6%, p<0.001) as was inappropriate prescribing for cellulitis (25.7% v 19.0%, p = <0.001). A higher rate of inappropriate prescribing was noted for some high-risk infections in RRH (e.g. empiric therapy for sepsis) compared to major-city hospitals.

Implications/Outcomes for Planned Research Project

Cellulitis was a common indication for which antimicrobials were frequently prescribed inappropriately in regional and remote hospitals, and this needs to be improved. Based on these findings, a cellulitis project involving a novel bundle of care is planned. The bundle of care will be developed and implemented in regional hospitals, with Ballarat Health Services being the lead site.

Final Thoughts

Antimicrobial prescribing was more frequently inappropriate for some high-risk infections treated in regional and remote hospitals. Strategies supporting appropriate antimicrobial prescribing for these conditions are also required. A manuscript based on this analysis has been accepted for publication in the International Journal of Antimicrobial Agents.