Appropriateness of acute-care antibiotic prescriptions for community-acquired infections and surgical antibiotic prophylaxis in England: analysis of 2016 national point prevalence survey data

H Higgins; R Freeman; A Doble; G Hood; J Islam; S Gerver; K L Henderson; A Demirjian; S Hopkins; D Ashiru-Oredope

doi:10.1016/j.jhin.2023.10.006

Appropriateness of acute-care antibiotic prescriptions for community-acquired infections and surgical antibiotic prophylaxis in England: analysis of 2016 national point prevalence survey data

J Hosp Infect. 2023 Dec:142:115-129. doi: 10.1016/j.jhin.2023.10.006. Epub 2023 Oct 17.

Authors

H Higgins¹, R Freeman², A Doble³, G Hood⁴, J Islam⁵, S Gerver⁵, K L Henderson⁵, A Demirjian⁶, S Hopkins⁵, D Ashiru-Oredope⁵

Affiliations

¹ Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK. Electronic address: hannah.higgins@ukhsa.gov.uk.
² Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; IQVIA, London, UK.
³ Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; Health Education England North West, Manchester, UK.
⁴ Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; NHS England (Midlands), Birmingham, UK.
⁵ Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK.
⁶ Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA, Previously Public Health England (PHE)), London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK.

PMID: 37858806
DOI: 10.1016/j.jhin.2023.10.006

Abstract

Background: Estimates of inappropriate prescribing can highlight key target areas for antimicrobial stewardship (AMS) and inform national targets.

Objectives: To (1) define and (2) produce estimates of inappropriate antibiotic prescribing levels within acute hospital trusts in England.

Methods: The 2016 national Healthcare-Associated Infections (HAI), Antimicrobial Use (AMU) and AMS point prevalence survey (PPS) was used to derive estimates of inappropriate prescribing, focusing on the four most reported community-acquired antibiotic indications (CAIs) in the PPS and surgical prophylaxis. Definitions of appropriate antibiotic therapy for each indication were developed through the compilation of national treatment guidelines. A Likert-scale system of appropriateness coding was validated and refined through a two-stage expert review process.

Results: Antimicrobial usage prevalence data were collected for 25,741 individual antibiotic prescriptions, representing 17,884 patients and 213 hospitals in England. 30.4% of prescriptions for the four CAIs of interest were estimated to be inappropriate (2054 prescriptions). The highest percentage of inappropriate prescribing occurred in uncomplicated cystitis prescriptions (62.5%), followed by bronchitis (48%). For surgical prophylaxis, 30.8% of prescriptions were inappropriate in terms of dose number, and 21.3% in terms of excess prophylaxis duration.

Conclusions: The 2016 prevalence of inappropriate antibiotic prescribing in hospitals in England was approximated to be 30.4%; this establishes a baseline prevalence and provided indication of where AMS interventions should be prioritized. Our definitions appraised antibiotic choice, treatment duration and dose number (surgical prophylaxis only); however, they did not consider other aspects of appropriateness, such as combination therapy - this is an important area for future work.

Keywords: Acute care; Antimicrobial; Antimicrobial resistance; Antimicrobial stewardship; Inappropriate prescribing; Prescribing.

MeSH terms

Anti-Bacterial Agents / therapeutic use
Anti-Infective Agents* / therapeutic use
Antibiotic Prophylaxis
Community-Acquired Infections* / drug therapy
Community-Acquired Infections* / prevention & control
Drug Prescriptions
England / epidemiology
Humans
Prescriptions
Prevalence

Substances

Anti-Bacterial Agents
Anti-Infective Agents