title: What are the similarities and differences in antimicrobial prescribing between Australian public and private hospitals?
abstract: BACKGROUND
  Identifying themes associated with inappropriate prescribing in Australian public and private hospitals will help target future antimicrobial stewardship initiatives.
  
  
  OBJECTIVE
  To describe current antimicrobial prescribing practices, identify similarities and differences between hospital sectors and provide target areas for improvement specific to each hospital sector.
  
  
  METHODS
  All hospitals included in the study were part of the 2014 national antimicrobial prescribing survey and conducted one of the following: a whole hospital point prevalence survey, serial point prevalence surveys or a sample of randomly selected patients. Data on the types of antibiotics used, their indications for use and the quality of prescription based on compliance with national and local prescribing guidelines were collected.
  
  
  RESULTS
  Two hundred and two hospitals (166 public and 36 private) comprising 10 882 patients and 15 967 antimicrobial prescriptions were included. Public hospitals had higher proportions of prescriptions for treatment (81.5% vs 48.4%) and medical prophylaxis (8.8% and 4.6%), whilst private hospitals had significantly higher surgical prophylaxis use (9.6% vs 46.9%) (P < 0.001). In public hospitals, the main reasons for non-compliance of treatment prescriptions were spectrum being too broad (30.5%) while in private it was incorrect dosing. Prolonged duration was the main reason for non-compliance among surgical prophylaxis prescriptions in both types of hospitals.
  
  
  CONCLUSIONS
  Australian hospitals need to target specific areas to improve antimicrobial use. Specifically, unnecessary broad-spectrum therapy should be a priority area in public hospitals, whilst emphasis on curtailing antimicrobial overuse in surgical prophylaxis needs to be urgently addressed across in the private hospital sector.
authors: National Centre for Antimicrobial Stewardship at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.|School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.
authors: M O
authors: MO
authors: Cotta
authors: National Centre for Antimicrobial Stewardship at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors: C
authors: C
authors: Chen
authors: Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.|Melbourne EpiCentre, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: M
authors: M
authors: Tacey
authors: National Centre for Antimicrobial Stewardship at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors: R S
authors: RS
authors: James
authors: National Centre for Antimicrobial Stewardship at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors: K L
authors: KL
authors: Buising
authors: National Centre for Antimicrobial Stewardship at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors: C
authors: C
authors: Marshall
authors: National Centre for Antimicrobial Stewardship at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia. karin.thursky@mh.org.au.
authors: K A
authors: KA
authors: Thursky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001315:Australia; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial stewardship; guidelines; hospitals; prescribing