title: Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.
abstract: BACKGROUND
  Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription.
  
  
  RESULTS
  Experienced infectious diseases (ID) fellows performed audits of antimicrobial use at regular intervals among all patients--with or without antimicrobials--hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4%) had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4%) prescriptions were for therapy and 312 (24.6%) for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%); incorrect choice of antimicrobials (7.6%); incorrect application of drugs (9.3%); and divergence from institutional guidelines (8%). Characteristics of inappropriate prophylaxes were: No indication (9%); incorrect choice of antimicrobials (1%); duration too long or other inappropriate use (6.7%). Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results.
  
  
  CONCLUSIONS
  Audits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial prescriptions without indication, and divergence from institutional guidelines were frequent errors. Based on these results, we will tailor education, amend institutional guidelines and further develop the infectious diseases consultation service.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Alexia
authors.initials: A
authors.lastname: Cusini
authors.forename: Silvana K
authors.initials: SK
authors.lastname: Rampini
authors.forename: Vineeta
authors.initials: V
authors.lastname: Bansal
authors.forename: Bruno
authors.initials: B
authors.lastname: Ledergerber
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Kuster
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects; D003141:Communicable Diseases / Q000139:chemically induced / Q000453:epidemiology; D000075202:Contraindications; D017723:Drug Utilization Review / Q000379:methods / Q000706:statistics & numerical data; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D015995:Prevalence; D013531:Surgicenters / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents