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Assessment of adherence to printed guidelines for antimicrobial drug use in a university hospital
  1. Nives Radošević Quadranti1,
  2. Branislava Popović2,
  3. Ivana Škrobonja3,
  4. Nataša Skočibušić4,
  5. Vera Vlahović-Palčevski1,5
  1. 1Department of Pharmacology, University of Rijeka Medical School, Rijeka, Croatia
  2. 2Department of Family Medicine, University of Rijeka Medical School, Rijeka, Croatia
  3. 3Department of Clinical Microbiology, University Hospital Centre Rijeka, Rijeka, Croatia
  4. 4University of Rijeka Medical School, Rijeka, Croatia
  5. 5Department of Clinical Pharmacology, University Hospital Centre Rijeka, Rijeka, Croatia
  1. Correspondence to Dr Nives Radošević Quadranti, Department of Pharmacology, University of Rijeka Medical School, Braće Branchetta 20, Rijeka 51000, Croatia; nives051{at}


Objectives To assess the quality of antimicrobial prescribing and the level of adherence to the guidelines in the department of medicine at a university hospital.

Methods A point prevalence survey was conducted between September 2008 and May 2011 at four selected time points. Demographic and relevant clinical patient data for those receiving antibiotic treatment were recorded. The necessity of antimicrobial treatment was assessed according to a scoring system based on the presence of signs and symptoms of an infection. Antibiotic use was judged according to Guidelines for hospital antimicrobial drug use published in December 2008.

Results The percentage of patients receiving antimicrobials varied from 30.8% (N=73) (September 2008) to 25.1% (N=60) (May 2011). At the first time point, 37.3% (N=25) of patients received antimicrobial therapy that was not necessary significantly more often than at other time points (p<0.01). Level of adherence to the guidelines varied between 35.0% (April 2009) and 50.0% (May 2011). The highest level of non-compliance with the guidelines was observed when cefuroxime, ceftriaxone and ciprofloxacin were prescribed.

Conclusions Our study demonstrates a continuous overuse of broad-spectrum antibiotics. A decrease in unnecessary antibiotic use and an increase in treatments based on susceptibility testing were noted in the periods when the guidelines were in use. This speaks in favour of guidelines for antimicrobial treatment being a valuable part of antimicrobial stewardship programmes.

  • antimicrobials
  • prescribing
  • guidelines
  • hospital
  • point-prevalence survey

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