A multicenter point-prevalence study: antimicrobial prescription frequencies in hospitalized patients in turkey

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Abstract

Background

Accurate information about prescribing patterns in hospitals is valuable in improving the quality of antimicrobial prescriptions.

Methods

Data on the use of antimicrobial agents in eighteen tertiary care hospitals were collected on March 20th 2002.

Results

One or more antimicrobials were ordered in 2900 (30.6 %)of 9471 hospitalized patients. The reasons of hospitalization of the patients receiving antimicrobials were medical treatment (42.5 %), elective surgery (39.6 %), treatment of infectious disease (17.1 %) and emergent surgical procedures (10.4 %). The highest consumption frequencies were found in surgical (81.6 %) and medical (55.2 %) intensive care units. The 48.8 % of antimicrobials were given for treatment and 44.2 % for prophylactic use. The most common reasons for treatment were found as lower respiratory tract, urinary tract, surgical wound infections and febrile neutropenia. Antimicrobials were ordered empirically in 78.4 % of patients. The proven infection ratio was found as 30.7 %. The 56.4 % and 13.4 % of orders were evaluated as clinically and microbiologically appropriate respectively.

Conclusion

These results suggest that antimicrobial prescription and empirical treatment ratios were high and inappropriate at inpatient groups.

Related collections

Most cited references 13

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Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity.

Michelle Hecker, David Aron, Nilam P. Patel … (2003)

Unnecessary use of antimicrobials contributes to the emergence and dissemination of antimicrobial-resistant nosocomial pathogens in part through elimination of normal anaerobic bacterial flora that inhibit overgrowth of pathogenic microorganisms. A prospective observational study was conducted in a 650-bed, university-affiliated hospital. All adult nonintensive care inpatients for whom new antimicrobials were prescribed during a 2-week period were monitored throughout their hospitalization. We examined how often antimicrobials, in particular those with antianaerobic activity, were used unnecessarily. The reasons for unnecessary therapy were assessed and common patterns of unnecessary use were identified. A total of 1941 antimicrobial days of therapy were prescribed for 129 patients. A total of 576 (30%) of the 1941 days of therapy were deemed unnecessary. The most common reasons for unnecessary therapy included administration of antimicrobials for longer than recommended durations (192 days of therapy), administration of antimicrobials for noninfectious or nonbacterial syndromes (187 days of therapy), and treatment of colonizing or contaminating microorganisms (94 days of therapy). Antianaerobic agents accounted for 203 (35%) of the 576 unnecessary antimicrobial days of therapy, and these agents were also frequently prescribed (98 days of therapy) when equally efficacious alternative regimens with minimal antianaerobic activity were available. In our institution, hospitalized patients frequently received unnecessary antimicrobial therapy, and antianaerobic agents were often prescribed when this spectrum of activity was not indicated.

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Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital.

Mayer N. Fishman, Biku John (1997)

Controlling antimicrobial costs has preoccupied infectious diseases physicians (IDPs). IDPs have controlled antimicrobial costs by the use of eight strategies: education, formulary restriction, pharmacy justification, formulary substitution, computer surveillance, laboratory item cost listing, purchase plans, and multidisciplinary approaches. Most strategies had input from IDPs and resulted in cost savings (up to $500,000 annually), particularly during the initiation periods. Educational efforts were successful in reducing costs but needed continual intervention. Formulary restriction was the most straightforward cost-control mechanism. Restriction of "target antimicrobials" has given way to "switch" therapy between expensive and less costly agents or between parenteral and oral regimens. Switch therapy is facilitated through the use of innovative order forms and on-line computer interaction. Computer surveillance has a capacity for interactive controls. Purchase plans may give way to centralized pharmacy monitoring, a strategy that is attractive to managed care organizations. Multidisciplinary antimicrobial management programs (AMPs) offer the best potential for sustaining savings in antimicrobial costs. Ten recommendations lay a groundwork for IDPs to translate their expertise into leadership of AMPs.

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Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist--a UK perspective.

Emily A. Holmes, Jay B. Dean, K. Knox … (2003)

Improved clinical outcome, patient safety, cost savings and a reduction in the burden of antimicrobial resistance are outcomes associated with optimizing antimicrobial use. Despite this, the misuse of antimicrobials in the hospital setting remains a huge problem. The development of antimicrobial management teams and the promotion of the role of the clinical pharmacist in antimicrobial prescribing are recommended strategies for improving prescribing practice. It is recognized that there is a lack of published evidence-based research looking at the effects of antimicrobial control programmes and there is a need for more data. In the UK, the role of the hospital pharmacist in promoting responsible antimicrobial prescribing has been largely undervalued and needs to be encouraged and formalized in line with current directives. Managerial structures within hospitals need to endorse multidisciplinary antimicrobial management schemes with appropriate authoritative, administrative and information technology support. Copyright 2003 The Hospital Infection Society

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Author and article information

Journal

Journal ID (nlm-ta): Ann Clin Microbiol Antimicrob

Title: Annals of Clinical Microbiology and Antimicrobials

Publisher: BioMed Central (London )

ISSN (Electronic): 1476-0711

Publication date Collection: 2005

Publication date (Electronic): 3 October 2005

Volume: 4

Page: 16

Affiliations

[1 ]Osmangazi University, Faculty of Medicine, Department of Infectious Diseases, Eskisehir-Turkey

[2 ]Ondokuz Mayis University, Faculty of Medicine, Department of Infectious Diseases, Samsun-Turkey

Article

Publisher ID: 1476-0711-4-16

DOI: 10.1186/1476-0711-4-16

PMC ID: 1276781

PubMed ID: 16202139

SO-VID: 1c1e25a9-946b-443a-9b6b-0eb0e51408cc

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A multicenter point-prevalence study: antimicrobial prescription frequencies in hospitalized patients in turkey

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Abstract

Background

Methods

Results

Conclusion

Related collections

Point-of-Care Testing for Infectious Diseases Super Collection

Most cited references 13

Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity.

Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital.

Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist--a UK perspective.

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