Volume 196 - Issue 1
Early experience with antimicrobial stewardship ward rounds at a tertiary referral hospital
Authors: Kelly A Cairns, Adam W J Jenney, Sushena Krishnaswamy, Michael J Dooley, Orla Morrissey, Sharon R Lewin and Allen C Cheng
Med J Aust 2012; 196 (1): 34-35. || doi: 10.5694/mja11.10809
Published online: 16 January 2012
Published online: 16 January 2012
To the Editor: Antimicrobial resistance has been identified as a major concern in Australia, particularly as few new antimicrobial agents are being developed.1 Studies suggest that up to half of antimicrobial agents prescribed in hospitals are inappropriate.2-4 Antimicrobial stewardship interventions, including dissemination of clinical guidelines and restrictions on antimicrobial formularies, may not be fully able to account for the complex indications for antimicrobial use in hospitalised patients.
We instituted a rapid clinical audit and feedback system of patients on one of 14 restricted antimicrobial agents as a component of antimicrobial stewardship activities in 2011 at the Alfred Hospital in Melbourne. Multidisciplinary antimicrobial stewardship ward rounds involving a senior clinical pharmacist, an infectious diseases (ID) registrar and an ID physician were performed on weekdays. Patients in units (respiratory, haematology/bone marrow transplantation, burns and intensive care) who had existing liaison ID services were excluded from our analysis. Patients included in the analysis were prescribed a restricted antimicrobial, either for an indication outside hospital policies, or where approval had not been obtained through a web-based antimicrobial approval system.
Between January and April 2011, 473 patients were identified as requiring review by the antimicrobial stewardship team. In total, 236 recommendations (Box) were made for 158 patients across all 18 units (73% surgical, 27% medical). For other patients, antimicrobial use was deemed clinically justified or the antimicrobial agent had been ceased at the time of review. Recommended changes to therapy involved ceftriaxone (n = 70), piperacillin/tazobactam (n = 23), ciprofloxacin (n = 22) and vancomycin (n = 18). A formal referral to the ID consultation service was made for 11 of the 236 patients (5%). Recommendations were followed in 78% (184/236) of cases; acceptance of recommendations was higher when review involved the ID physician (146/176, 83%) than when it did not (38/60, 63%; P = 0.002).
Rapid clinical review by a multidisciplinary antimicrobial stewardship team was able to assess large numbers of patients requiring restricted antimicrobial agents. Postprescribing evaluation has been reported mainly in North American studies, but has not been reported in Australian hospitals.5 In most patients, agreement was reached with the treating clinicians to cease or reduce the use of antimicrobial agents, suggesting that their ongoing use was not clinically justified. In addition, regular ward rounds by the team supported compliance with the antimicrobial approval system, provided education to junior medical staff and identified antimicrobial use protocols that had no basis in evidence.
Competing interests
No relevant disclosures.
References
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