An audit of antibiotic prescriptions: an antimicrobial stewardship pre-implementation study at a tertiary care public hospital.

Abstract

Objective: To audit the prescribing of antibiotics at a tertiary-level public hospital, in preparation for the implementation of an antimicrobial stewardship programme.

Methods: A retrospective audit of antibiotic prescriptions for the period April 2020 to June 2020 was conducted to ascertain appropriate antibiotic prescribing based on a set of process measures, which included whether cultures were taken before the initiation of empirical antibiotics, the duration of antibiotic therapy, de-escalation to a narrower spectrum antibiotic, the concurrent use of four or more antibiotics, documented indication for antibiotic use, and parenteral to oral conversion. Statistics were calculated using Stata (Version 17).

Results: A total of 380 patient medical charts were reviewed. It was noted that there were no standalone antibiotic charts, and antibiotics were prescribed alongside other medication in one prescription record. There was non-compliance to one or more of the process measures in two-thirds of antibiotic prescriptions audited. Excessive duration of therapy was evident in 3.16% (12) prescriptions. There were 18 (4.74%) instances in which de-escalation to a narrower spectrum antibiotic based on susceptibility results did not occur. Only a small proportion of patients were switched from parenteral to oral antibiotics (n = 12, 3.16%). Some of the additional findings included redundant antibiotic coverage (n = 137, 36.05%) and prescription of an antibiotic that did not align with the susceptibility results (n = 98, 25.79%).

Conclusions: Inappropriate antibiotic prescribing did occur in some cases. The results from this pre-implementation study highlight the importance of introducing antimicrobial stewardship interventions with process and outcome measures.