Background Inappropriate prescription of restricted antibiotics is a major public health concern and is related to the development of antimicrobial resistance.
Purpose The aim of this study was to assess the appropriateness of restricted antibiotic prescriptions by non-infectious disease physicians in a hospital setting in Spain.
Material and methods A prospective study was undertaken in patients with restricted antibiotic prescription (cefepime, daptomicine, ertapenem, imipenem, linezolid, meropenem and piperacillin/tazobactam) over a period of 6 months (January 2016–June 2016). The prescription was validated on day 4 by the infectious disease physician and the pharmacist according to the institutional clinical practice guidelines. Data were collected from medical records, which also stored sociodemographic characteristics, medical conditions, symptoms that required medical attention, diagnosis, prescribed antibiotic and whether or not cultures were ordered.
Results 77 patients were included (61% men, median age 62 years), with a median of 8 days (3–19) of antibiotic treatment. The most prescribed restricted antibiotics were Imipenem (35%), piperacillin/tazobactam (18%), ertapenem (29%) and cefepime(14%). In 48 (62%) of the prescriptions, the physician did not order blood cultures and in 20 (26%) no culture.
26 (33.7%) recommendations to de-escalate antibiotics were made and 16 (62%) were accepted. The most frequent prescribers were surgeons and internal medicine physicians, and almost half of the illnesses for which antibiotics were prescribed were respiratory tract infections (22%) and cholecystitis and cholangitis (21%). The restricted antibiotics that were more appropriately prescribed were piperacillin/tazobactam (75%), ertapenem (58%), meropenem (50%) and imipenem (50%).
Admission to a medical ward was more likely to be associated with correct antibiotic use (61%) than having surgery (53%). Having a healthcare institution acquired infection was more likely to be associated with appropriate antibiotic use (73%) than having a community acquired infection (64%).
Conclusion This study shows a high prevalence of patients with a prescription for restricted antibiotics and without a blood culture. Moreover, it shows inappropriate restricted antibiotic prescriptions in our hospital. Therefore, actions such as educational programmes should be considered to optimise restricted antibiotic prescriptions.
No conflict of interest
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