title: Identifying targets for quality improvement in hospital antibiotic prescribing.
abstract: OBJECTIVE
  To audit antibiotic use in a university hospital and to identify targets for quality improvement in a setting with low antibiotic use and resistance rates.
  
  
  METHODS
  A point-prevalence survey (PPS), using a patient-based audit tool for antibiotic use, was executed in the Radboud University Medical Centre in May 2013. On one index day, all patients on systemic antibiotics hospitalised > 24 hours were included. Data regarding antibiotic prescriptions were extracted from the medical records. Multiple logistic regression analysis was performed in order to predict whether a variable was associated with low guideline compliance or a low rate of consulting an infectious disease specialist.
  
  
  RESULTS
  428 hospitalised patients were included, of whom 40.9% received antibiotics. Overall, 75.7% of all prescriptions were compliant with the guidelines in place and for 87.8% the reason for prescription was documented. Amoxicillin/clavulanic acid (OR = 4.08, 95% CI 1.57-10.56), and respiratory tract infections (RTI) (OR = 6.17, 95% CI 2.55-14.94) were associated with low compliance with guidelines. An infectious disease physician or medical microbiologist was less often consulted for empirical therapy (OR 23.21, 95% CI 6.37-84.51) or empirical therapy continued > 72 hours (OR 14.69, 95% CI 3.56-60.56) compared with prescriptions that were based on culture results. In addition, fewer consultations were requested for RTI (OR 4.47, 95% CI 1.39-14.35).
  
  
  CONCLUSIONS
  A PPS is a good tool to identify targets for antibiotic stewardship in routine clinical practice. Several areas for improvement, such as a low compliance with guidelines for amoxicillin/clavulanic acid and RTI, and a low rate of consulting an infectious disease physician or medical microbiologist concerning antibiotic therapy in case of RTI and empirical therapy continued > 72 hours were identified.
authors.affiliation: Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands.
authors.forename: P C J M
authors.initials: PC
authors.lastname: van Spreuwel
authors.forename: H
authors.initials: H
authors.lastname: Blok
authors.forename: M F M
authors.initials: MF
authors.lastname: Langelaar
authors.forename: B J
authors.initials: BJ
authors.lastname: Kullberg
authors.forename: J W
authors.initials: JW
authors.lastname: Mouton
authors.forename: S
authors.initials: S
authors.lastname: Natsch
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D001170:Arthritis, Infectious / Q000188:drug therapy; D002494:Central Nervous System Infections / Q000188:drug therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007239:Infections / Q000188:drug therapy*; D016015:Logistic Models; D008485:Medical Audit; D009426:Netherlands; D010019:Osteomyelitis / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012141:Respiratory Tract Infections / Q000188:drug therapy; D018461:Soft Tissue Infections / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents