Inappropriate prescribing of antibiotics rife

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New hospital survey reveals 60% of antibiotics given to patients after surgery were prescribed inappropriately

The Surgical National Antimicrobial Prescribing Survey (SNAPS) is an annual survey of antimicrobial prescribing for the prevention of infections in surgical settings across Australian hospitals.

Sixty-seven public and private hospitals participated in SNAPS for the 2016 pilot, the results of which were published this week.

More than 4,500 surgical episodes were included in the analysis of the survey, which was conducted between April and November 2016.

Antimicrobials administered either immediately prior to or during the surgical procedure were prescribed in 58.6% of these episodes.

Findings from the new survey reveal over 43% of antibiotics given to patients before or during surgery to prevent postoperative infections fell short of good prescribing practice in at least one respect.

The most common reason for inappropriate prescribing in these instances was incorrect timing.

Post-procedural antimicrobials were prescribed in 27.7% of episodes, and more than half (60%) of these were prescribed inappropriately.

The most common reason for inappropriate prescribing post-surgery was that no antimicrobial was actually required.

Almost all procedure groups had high rates of overall inappropriateness.

Only thoracic surgery, obstetrics, ophthalmology, gynaecological surgery and gastrointestinal endoscopic procedures had less than 40% of prescriptions with one or more elements of inappropriate antimicrobial prescribing.

Cefazolin was the most common antimicrobial prescribed procedurally, with 2,200 (69.0%) doses.

Metronidazole and gentamicin were the next most commonly prescribed with 210 (6.6%) and 176 (5.5%) doses respectively.

Antibiotics “allow us to perform complex and vital surgical procedures, but we must make sure they are used appropriately and only when they are really necessary,” says Professor John Turnidge, Senior Medical Advisor at the Australian Commission on Safety and Quality in Health Care.

“This is a critical patient safety issue.”

Professor Karin Thursky, director of the National Centre for Antimicrobial Stewardship, says this type of review “enables participating hospitals to reflect on opportunities to improve the safety and quality of antimicrobial use”.

She encouraged all Australian hospitals to participate in the SNAPS next year as part of their quality improvement activities.

See the full survey results here.

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