澳大利亚医院皮肤和软组织管理中抗菌药物处方的质量：国家抗菌药物处方调查数据分析。

The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data.

机构信息

Melbourne Medical School, University of Melbourne, Melbourne, Australia.

Melbourne Medical School, University of Melbourne, Melbourne, Australia; National Centre for Antimicrobial Stewardship at the Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia.

出版信息

J Hosp Infect. 2024 Oct;152:142-149. doi: 10.1016/j.jhin.2024.06.016. Epub 2024 Jul 18.

DOI:10.1016/j.jhin.2024.06.016

PMID:39032563

Abstract

BACKGROUND

Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice.

METHODS

A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness.

RESULTS

From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350).

CONCLUSIONS

As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.

摘要

背景

皮肤和软组织感染（SSTI）是医院中最常见的抗生素使用指征之一。抗生素使用不当会导致发病率增加、不必要的医院再入院和抗生素耐药性增加。本研究旨在评估澳大利亚医院 SSTI 管理中抗生素使用的质量，为未来的实践提供指导。

方法

对国家抗生素使用调查（NAPS）的数据进行回顾性分析。对医院 NAPS（2013-2022 年）的 SSTI 处方数据和外科 NAPS（2016-2022 年）的手术部位感染数据进行分析。评估的变量包括指南遵从性、根据结构化 NAPS 算法的适当性以及不适当的原因。

结果

从医院 NAPS 数据集分析了 40535 例 SSTI 的抗生素处方。最常见的指征是蜂窝织炎（34.1%，N=13822），最常开的抗生素是氟氯西林（18.8%，N=7638）。SSTI 指征的指南遵从性较低，但与抗生素处方的所有其他指征相比，适当性较高（指南遵从性 66.3%，N=21035 比 67.4%，N=156285；适当性 75.6%，N=30639 比 72.7%，N=209383）。不适当的最常见原因是剂量或频率不正确（29.3%，N=2367）。从外科 NAPS 数据集分析了 5674 例手术部位感染的处方。其中，68.2%（N=3867）被认为是适当的。不适当的最常见原因是剂量或频率不正确（27.7%，N=350）。