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. 2022 Spring;75(2):79-88.
doi: 10.4212/cjhp.v75i2.3093. Epub 2022 Apr 4.

A Point Prevalence Survey of Antimicrobial Usage in New Brunswick Hospitals

Rachel Cormier  1 , Tim MacLaggan  2 , Daniel Landry  3 , Rachel Harris  4 , Andrew Flewelling  5
Affiliations

A Point Prevalence Survey of Antimicrobial Usage in New Brunswick Hospitals

Rachel Cormier et al. Can J Hosp Pharm. 2022 Spring.

Abstract
in English, French

Background: Prevalence surveys are useful tools for assessing the appropriateness of antimicrobial therapy.

Objectives: The primary objective was to assess patterns of antimicrobial utilization and appropriateness in New Brunswick hospitals. The secondary objective was to assess the impact of hospital size and the presence of a penicillin allergy label on antimicrobial appropriateness.

Methods: A point prevalence survey was conducted of inpatients taking 1 or more systemic antimicrobials during admission to hospitals in New Brunswick. A structured protocol and web-based data collection tool (National Antimicrobial Prescribing Survey) were used for this survey. Data regarding hospital size and presence of a penicillin allergy label were also collected. Antimicrobial utilization was assessed in terms of guideline compliance and appropriateness. Results were summarized descriptively. A χ2 analysis was performed to describe secondary outcomes.

Results: Ten hospitals participated, and a total of 2200 patients were admitted at the time of the survey. The overall prevalence of antimicrobial use was 22.7% (500/2200). A total of 648 antimicrobials were ordered. The most frequently prescribed antimicrobials by class were first-generation cephalosporins (14.0%, 91/648), third-generation cephalosporins (11.3%, 73/648), and piperacillin-tazobactam (10.2%, 66/648). The most common indications for antimicrobial therapy were respiratory tract infections (27.3%, 177/648), urinary tract infections (12.2%, 79/648), and intra-abdominal infections (11.4%, 74/648). Compliance with local or regional treatment guidelines, where applicable, was 66.2% (188/284). Provincially, 68.1% (441/648) of the antimicrobial orders were deemed appropriate. Larger centres had substantially higher rates of appropriateness (p < 0.001). The presence of a penicillin allergy label had no impact on appropriateness (p = 0.21).

Conclusions: Several opportunities for targeted interventions were identified to improve antimicrobial prescribing, including decreasing the use of broad-spectrum antimicrobials, increasing guideline compliance, and ensuring documentation of antimicrobial duration by prescribers.

Contexte: Les enquêtes de prévalence sont des outils utiles permettant d’évaluer la pertinence de la thérapie antimicrobienne.

Objectifs: L’objectif principal consistait à évaluer les modèles d’utilisation des antimicrobiens et leur pertinence dans les hôpitaux du Nouveau-Brunswick. L’objectif secondaire consistait, quant à lui, à évaluer l’effet de la taille de l’hôpital et de la présence d’une étiquette indiquant une allergie à la pénicilline sur la pertinence des antimicrobiens.

Méthodes: Une enquête ponctuelle a été menée auprès de patients hospitalisés prenant un ou plusieurs antimicrobiens systémiques lors de leur admission dans des hôpitaux du Nouveau-Brunswick. Un protocole structuré et un outil de collecte de données en ligne (National Antimicrobial Prescribing Survey, ou enquête nationale sur la prescription d’antimicrobiens) ont été utilisés pour cette enquête. Des données concernant la taille de l’hôpital et la présence d’une étiquette indiquant une allergie à la pénicilline ont aussi été recueillies. L’utilisation des antimicrobiens a été évaluée sur le plan de la pertinence et de la conformité aux lignes directrices. Les résultats ont été résumés de manière descriptive. Une analyse χ2 a été effectuée pour décrire les résultats secondaires.

Résultats: Dix hôpitaux ont participé, et un total de 2200 patients ont été admis au moment de l’enquête. La prévalence globale de l’utilisation d’antimicrobiens était de 22,7 % (500/2200). Au total, 648 antimicrobiens ont été prescrits. Les antimicrobiens les plus fréquemment prescrits (par classe) étaient les céphalosporines de première génération (14,0 %, 91/648); les céphalosporines de troisième génération (11,3 %, 73/648); et la pipéracilline-tazobactam (10,2 %, 66/648). Les indications les plus courantes de l’antibiothérapie étaient les infections des voies respiratoires (27,3 %, 177/648), les infections des voies urinaires (12,2 %, 79/648) et les infections intra-abdominales (11,4 %, 74/648). Le respect des directives de traitement locales ou régionales, le cas échéant, était de 66,2 % (188/284). À l’échelle provinciale, 68,1 % (441/648) des ordonnances d’antimicrobiens ont été jugées appropriées. Les grands centres avaient des taux de pertinence sensiblement plus élevés (p < 0,001). La présence d’une étiquette indiquant une allergie à la pénicilline n’a eu aucun effet sur la pertinence (p = 0,21).

Conclusions: Plusieurs occasions d’interventions ciblées ont été dégagées pour améliorer la prescription d’antimicrobiens, y compris la diminution de l’utilisation d’antimicrobiens à large spectre, une plus grande conformité aux lignes directrices et l’assurance que la durée de l’antimicrobien est consignée par les prescripteurs.

Keywords: antimicrobial; antimicrobial utilization; antimicrobien; appropriateness; enquête de prévalence; gestion responsable; pertinence; prevalence survey; stewardship; utilisation des antimicrobiens.

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Conflict of interest statement

Competing interests: For activities outside the scope of the study published here, Daniel Landry has received a research grant and reimbursement of travel expenses from Baxter. No other competing interests were declared.

Figures

FIGURE 1
FIGURE 1
Top 10 indications for antimicrobial use in New Brunswick hospitals.
FIGURE 2
FIGURE 2
Antimicrobial agents most frequently prescribed in New Brunswick hospitals.
FIGURE 3
FIGURE 3
Summary of level of antimicrobial appropriateness in New Brunswick hospitals.
FIGURE 4
FIGURE 4
Assessment of appropriateness for the top 4 broad-spectrum antimicrobial agents. Numbers of antimicrobial orders: n = 22 for carbapenems, n = 63 for ceftriaxone, n = 59 for fluoroquinolones, and n = 66 for piperacillin–tazobactam.
See this image and copyright information in PMC

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