Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit
Abstract
:1. Introduction
2. Results
2.1. Overall
2.2. Excess DOTs
2.2.1. Excess Antibiotics at Initiation
2.2.2. Excess Antibiotics at Pre-72 h Review
2.2.3. Excess Antibiotics Due to Protracted Course Length
2.3. Excess Intravenous Antibiotic DOTs
3. Discussion
Study Biases
4. Materials and Methods
4.1. Setting
4.2. Ethics
4.3. Patient Identification
4.4. Data Collection
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- HM Government. Tackling Antimicrobial Resistance 2019–2024: The UK’s Five-Year National Action Plan; Department of Health and Social Care, HM Government: London, UK, 2019.
- Service NH. NHS Standard Contract. 2022/23 CQUIN. Available online: https://www.england.nhs.uk/nhs-standard-contract/cquin/2022-23-cquin/ (accessed on 15 September 2022).
- Service NH. NHS Standard Contract. 2022. Available online: https://www.england.nhs.uk/nhs-standard-contract/22-23/ (accessed on 15 September 2022).
- Budgell, E.P.; Davies, T.J.; Donker, T.; Hopkins, S.; Wyllie, D.H.; Peto, T.E.A.; Gill, M.J.; Llewelyn, M.J.; Walker, A.S. Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England. J. Infect. 2021, 84, 311–320. [Google Scholar] [CrossRef] [PubMed]
- D’Atri, F.; Arthur, J.; Blix, H.S.; Hicks, L.A.; Plachouras, D.; Monnet, D.L.; European Survey on Transatlantic Task Force on Antimicrobial Resistance (TATFAR) Action 1.2 Group. Targets for the reduction of antibiotic use in humans in the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) partner countries. Eur. Surveill. 2019, 24, 1800339. [Google Scholar] [CrossRef] [PubMed]
- Hood, G.; Hand, K.S.; Cramp, E.; Howard, P.; Hopkins, S.; Ashiru-Oredope, D. Measuring Appropriate antibiotic prescribing in acute hospitals: Development of a national audit tool through a Delphi consensus. Antibiotics 2019, 8, 49. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sawyer, R.G.; Claridge, J.A.; Nathens, A.B.; Rotstein, O.D.; Duane, T.M.; Evans, H.L.; Cook, C.H.; O’Neill, P.J.; Mazuski, J.E.; Askari, R.; et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N. Engl. J. Med. 2015, 372, 1996–2005, Erratum in N. Engl. J. Med. 2018, 378, 686. [Google Scholar] [CrossRef] [Green Version]
- Leeds, I.L.; Fabrizio, A.; Cosgrove, S.E.; Wick, E.C. Treating wisely: The surgeon’s role in antibiotic stewardship. Ann. Surg. 2017, 265, 871–873. [Google Scholar] [CrossRef] [Green Version]
- Charani, E.; De Barra, E.; Rawson, T.M.; Gill, D.; Gilchrist, M.; Naylor, N.R.; Holmes, A.H. Antibiotic prescribing in general medical and surgical specialties: A prospective cohort study. Antimicrob. Resist. Infect. Control 2019, 8, 151. [Google Scholar] [CrossRef]
- Tarrant, C.; Krockow, E.M. Antibiotic overuse: Managing uncertainty and mitigating against overtreatment. BMJ Qual. Saf. 2022, 31, 163–167. [Google Scholar] [CrossRef]
- Charani, E.; Tarrant, C.; Moorthy, K.; Sevdalis, N.; Brennan, L.; Holmes, A.H. Understanding antibiotic decision making in surgery-a qualitative analysis. Clin. Microbiol. Infect. 2017, 23, 752–760. [Google Scholar] [CrossRef] [Green Version]
- Sartelli, M.; Duane, T.M.; Catena, F.; Tessier, J.M.; Coccolini, F.; Kao, L.S.; De Simone, B.; Labricciosa, F.M.; May, A.K.; Ansaloni, L.; et al. Antimicrobial stewardship: A call to action for surgeons. Surg. Infect. 2016, 17, 625–631. [Google Scholar] [CrossRef] [Green Version]
- Cross, E.; Sivyer, K.; Islam, J.; Santillo, M.; Mowbray, F.; Peto, T.; Walker, A.; Yardley, L.; Llewelyn, M. Adaptation and implementation of the ARK (Antibiotic Review Kit) intervention to safely and substantially reduce antibiotic use in hospitals: A feasibility study. J. Hosp. Infect. 2019, 103, 268–275. [Google Scholar] [CrossRef]
- Powell, N.; Bamford, K.; Junior Doctor RCHT PHE Audit Team. Assessment of the appropriateness of antibiotic prescribing in an acute UK hospital using a national audit tool: A single-centre retrospective cohort study. JAC-Antimicrob. Resist. 2022, 4 (Suppl. S2), dlac053.002. [Google Scholar] [CrossRef]
- Llewelyn, M.J.; Budgell, E.P.; Laskawiec-Szkonter, M.; Cross, E.L.; Alexander, R.; Bond, S.; Coles, P.; Conlon-Bingham, G.; Dymond, S.; Evans, M.; et al. Antibiotic review kit for hospitals (ARK-Hospital): A stepped-wedge cluster-randomised controlled trial. Lancet Infect. Dis. 2022. [Google Scholar] [CrossRef]
- Costelloe, C.; Metcalfe, C.; Lovering, A.; Mant, D.; Hay, A.D. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ 2010, 340, c2096. [Google Scholar] [CrossRef] [Green Version]
- Lamb, G.; Phillips, G.; Charani, E.; Holmes, A.; Satta, G. Antibiotic prescribing practices in general surgery: A mixed methods quality improvement project. Infect. Prev. Pract. 2021, 3, 100166. [Google Scholar] [CrossRef] [PubMed]
- Labricciosa, F.M.; Sartelli, M.; Correia, S.; Abbo, L.M.; Severo, M.; Ansaloni, L.; Coccolini, F.; Alves, C.; Melo, R.B.; Baiocchi, G.L.; et al. Emergency surgeons’ perceptions and attitudes towards antibiotic prescribing and resistance: A worldwide cross-sectional survey. World J. Emerg. Surg. 2018, 13, 27. Available online: https://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=asx&AN=130390826&site=eds-live (accessed on 30 August 2022). [CrossRef]
- Popovski, Z.; Mercuri, M.; Main, C.; Sne, N.; Walsh, K.; Sung, M.; Rice, T.; Mertz, D. Multifaceted intervention to optimize antibiotic use for intra-abdominal infections. J. Antimicrob. Chemother. 2015, 70, 1226–1229. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Charani, E.; Ahmad, R.; Tarrant, C.; Birgand, G.; Leather, A.; Mendelson, M.; Moonesinghe, S.R.; Sevdalis, N.; Singh, S.; Holmes, A. Opportunities for system level improvement in antibiotic use across the surgical pathway. Int. J. Infect. Dis. 2017, 60, 29–34. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Janssen, R.M.E.; Oerlemans, A.J.M.; Van Der Hoeven, J.G.; Ten Oever, J.; Schouten, J.A.; Hulscher, M.E.J.L. Why we prescribe antibiotics for too long in the hospital setting: A systematic scoping review. J. Antimicrob. Chemother. 2022, 77, 2105–2119. [Google Scholar] [CrossRef] [PubMed]
- Schuts, E.C.; Hulscher, M.E.J.L.; Mouton, J.W.; Verduin, C.M.; Stuart, J.W.T.C.; Overdiek, H.W.P.M.; van der Linden, P.D.; Natsch, S.; Hertogh, C.M.P.M.; Wolfs, T.F.W.; et al. Current evidence on hospital antimicrobial stewardship objectives: A systematic review and meta-analysis. Lancet Infect. Dis. 2016, 16, 847–856, Erratum in Lancet Infect Dis. 2016, 16, 768. [Google Scholar] [CrossRef]
- Li, H.K.; Scarborough, M.; Zambellas, R.; Cooper, C.; Rombach, I.; Walker, A.S.; Lipsky, B.A.; Briggs, A.; Seaton, A.; Atkins, B.; et al. Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): Study protocol for a randomised controlled trial. Trials 2015, 16, 583. [Google Scholar] [CrossRef]
- Powell, N.; Stephens, J.; Rule, R.; Phillips, R.; Morphew, M.; Garry, E.; Askaroff, N.; Hiley, D.; Strachan, C.; Sheehan, M.; et al. Potential to reduce antibiotic use in secondary care: Single-centre process audit of prescription duration using NICE guidance for common infections. Clin. Med. 2021, 21, e39–e44. [Google Scholar] [CrossRef] [PubMed]
Characteristic | Patients (n = 86) |
---|---|
Sex | |
Male | 46 (53.5%) |
Female | 40 (46.5%) |
Age (years) | |
Median | 56 |
Inter Quartile Range (IQR) | 26 |
Audit week | |
Week 1 (2nd August–8th August) | 23 (26.7%) |
Week 2 (9th August–15th August) | 25 (29.1%) |
Week 3 (16th August–22nd August) | 18 (20.9%) |
Week 4 & 5 (23rd August–31st August) | 20 (23.3%) |
Infection diagnosis | 81 |
Surgical | 70 |
Abscess | |
Complex Pelvic | 2 |
Gluteal | 1 |
Hepatic | 3 |
Anorectal | 3 |
Pilonidal | 2 |
Thigh | 2 |
Appendicitis | 9 |
Bowel Obstruction | 6 |
Cholangitis | 3 |
Cholecystitis | 12 |
Colitis | 3 |
Contaminated wound | 2 |
Diverticulitis | 4 |
Fistula | 2 |
Gastroenteritis | 2 |
Haemorrhoids | 1 |
Infected Sebaceous Cyst | 1 |
Pancreatitis | 1 |
Perforated bowel | 3 |
Surgical Procedure | |
Cholecystectomy | 1 |
Extra-levator abdominal perineal resection | 1 |
Hartmanns | 1 |
Polyp removal | 2 |
Extended Surgical Prophylaxis | 3 |
Non-surgical | 11 |
Clostridioides difficile associated diarrhoea | 1 |
Hospital-acquired pneumonia | 3 |
Pyelonephritis | 2 |
Sepsis (undifferentiated) | 2 |
Urinary tract infections | 3 |
No final infection diagnosis | 5 |
Source | Excess DOTs | Percentage Excess DOTs of Total DOTs | ||||
---|---|---|---|---|---|---|
Total DOTs | At Antibiotic Initiation | At the Pre-72 h Antibiotic Review | Antibiotic Course Length | Total | ||
Infection Specialist consensus | 1162 | 82 | 68 | 73 | 223 | 19.9% |
Consultant Surgeon and infection specialist consensus | 1162 | 75 | 55 | 62 | 192 | 16.5% |
Consultant surgeon determined excess days (with some disagreement between infection specialists and surgeon) | 1162 | 67 | 51 | 42 | 160 | 13.8% |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Hearsey, D.J.; Bamford, K.B.; Hutton, M.; Wade, L.; Coates, H.; Ramsay, E.; Alberts, B.; Powell, N. Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit. Antibiotics 2022, 11, 1575. https://doi.org/10.3390/antibiotics11111575
Hearsey DJ, Bamford KB, Hutton M, Wade L, Coates H, Ramsay E, Alberts B, Powell N. Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit. Antibiotics. 2022; 11(11):1575. https://doi.org/10.3390/antibiotics11111575
Chicago/Turabian StyleHearsey, Daniel John, Kathleen B. Bamford, Michael Hutton, Liam Wade, Henry Coates, Elizabeth Ramsay, Barbara Alberts, and Neil Powell. 2022. "Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit" Antibiotics 11, no. 11: 1575. https://doi.org/10.3390/antibiotics11111575