Antimicrobial prescribing quality in Australian emergency departments: an analysis of the Hospital NAPS data set

Abstract

Abstract Objective: To analyze antimicrobial prescribing practices in Australian emergency departments (ED), identifying prescribing areas requiring improvement. This aims to inform antimicrobial stewardship (AMS) strategies to enhance antimicrobial prescribing quality. Design Retrospective analysis of the Hospital National Antimicrobial Prescribing Survey (NAPS) data set. Setting EDs in public and private Australian hospitals (n = 652). Participants Hospitals (n = 652) that participated in the Hospital NAPS from 2013 to 2022. Methods Data were collected by trained auditors from participating hospitals with the use of a standardized auditing tool, the Hospital NAPS. Data from 2013 to 2022 were analyzed descriptively. Variables assessed included guideline compliance and appropriateness by antimicrobial and indication, and reasons for inappropriateness. Results There were 3,098 antimicrobial prescriptions from EDs included for analysis. Guideline compliance (63.5%) and appropriateness (70.4%) in EDs were lower compared to overall prescribing practices from all departments. The most commonly prescribed antimicrobial was ceftriaxone (16.9%, n = 523), and the most common indication was empiric prescribing for community-acquired pneumonia (16.0%, n = 497). Amoxicillin-clavulanic acid (53.2%, n = 99), and acute exacerbation of chronic obstructive pulmonary disease (54.3%, n = 57), were the antimicrobial and indication with the lowest rates of appropriateness respectively. Ceftriaxone prescribing also had a low rate of appropriateness (62.3%, n = 326). Selection of antimicrobials with too broad of a spectrum was the most common reason for inappropriateness (40.2%). Conclusion Antimicrobial prescribing quality in EDs warrants improvement. Recommended targets for AMS interventions are the excessive and inappropriate use of broad-spectrum antimicrobials such as ceftriaxone and amoxicillin-clavulanic acid in common respiratory and urinary tract infections.