The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

• Published in: Antimicrobial resistance & infection control 2020-02, Vol.9 (1), p.40-40, Article 40
• Main Authors: van den Broek, Annemieke K, van Hest, Reinier M, Lettinga, Kamilla D, Jimmink, Afra, Lauw, Fanny N, Visser, Caroline E, Prins, Jan M
• Format: Article
• Language: English
• Subjects: Ambulatory care; Ambulatory care facilities; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination - pharmacology; Amoxicillin-Potassium Clavulanate Combination - therapeutic use; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Anti-infective agents; Antibiotic Prophylaxis - statistics & numerical data; Antibiotic stewardship; Antibiotics; Antimicrobial agents; Antimicrobial Stewardship - methods; Antimicrobials; Clinics; Departments; Disease control; Drug Dosage Calculations; Drug dosages; Drug resistance; Electronic Health Records; Electronic records; Guideline Adherence - statistics & numerical data; Health aspects; Hematology; Hospital outpatient clinics; Hospitals; Hospitals, Teaching; Hospitals, University; Humans; Inappropriate prescribing; Inappropriate Prescribing - statistics & numerical data; Kidney - drug effects; Kidney - physiology; Kidney Function Tests; Medical care quality; Medical records; Netherlands; Netherlands - epidemiology; Patients; Penicillins; Practice Guidelines as Topic; Prescription writing; Prescriptions; Prescriptions (Drugs); Prevalence; Prophylaxis; Renal function; Skin; Teachers; Therapeutics
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-020-0689-x

Antimicrobial Stewardship Programs commonly have an in-hospital focus. Little is known about the quality of antimicrobial use in hospital outpatient clinics. We investigated the extent and appropriateness of antimicrobial prescriptions in the outpatient clinics of three hospitals. From June 2018 to January 2019, we performed ten point prevalence surveys in outpatient clinics of one university hospital and two large teaching hospitals. All prophylactic and therapeutic prescriptions were retrieved from the electronic medical records. Appropriateness was defined as being in accordance with guidelines. Furthermore, we investigated the extent to which the dose was adjusted to renal function and documentation of an antibiotic plan in the case notes. We retrieved 720 prescriptions for antimicrobial drugs, of which 173 prescriptions (24%) were prophylactic. A guideline was present for 95% of prescriptions, of which the guideline non-adherence rate was 25.6% (n = 42/164) for prophylaxis and 43.1% (n = 224/520) for therapy. Of all inappropriate prescriptions (n = 266), inappropriate prescriptions for skin and soft tissue infections (n = 60/226) and amoxicillin-clavulanic acid (n = 67/266) made up the largest proportion. In only 13 of 138 patients with impaired or unknown renal function the dosage regimen was adjusted. Amoxicillin-clavulanic acid was the drug for which most often renal function was not taken into account. In 94.6% of prescriptions the antibiotic plan was documented. In hospital outpatient clinics, a substantial part of therapeutics were inappropriately prescribed. Amoxicillin-clavulanic acid was the most inappropriately prescribed drug, due to non-adherence to the guidelines and because dose adjustment to renal function was often not considered.