The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands
Abstract Objectives 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...
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-020-0689-x |
| _version_ | 1818409667813965824 |
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| author | Annemieke K. van den Broek Reinier M. van Hest Kamilla D. Lettinga Afra Jimmink Fanny N. Lauw Caroline E. Visser Jan M. Prins |
| author_facet | Annemieke K. van den Broek Reinier M. van Hest Kamilla D. Lettinga Afra Jimmink Fanny N. Lauw Caroline E. Visser Jan M. Prins |
| author_sort | Annemieke K. van den Broek |
| collection | DOAJ |
| description | Abstract Objectives 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. Methods 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. Results 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. Conclusions 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. |
| first_indexed | 2024-12-14T10:03:16Z |
| format | Article |
| id | doaj.art-53e0b5345ee64c679571b39ff8a39008 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-14T10:03:16Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-53e0b5345ee64c679571b39ff8a390082022-12-21T23:07:12ZengBMCAntimicrobial Resistance and Infection Control2047-29942020-02-01911910.1186/s13756-020-0689-xThe appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the NetherlandsAnnemieke K. van den Broek0Reinier M. van Hest1Kamilla D. Lettinga2Afra Jimmink3Fanny N. Lauw4Caroline E. Visser5Jan M. Prins6Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of AmsterdamDepartment of Hospital Pharmacy, Division of Clinical Pharmacology, Amsterdam UMC, University of AmsterdamDepartment of Internal medicine, Onze lieve vrouwe gasthuis, location WestDepartment of Hospital Pharmacy, Onze lieve vrouwe gasthuis, location WestDepartment of Internal medicine, MC SlotervaartDepartment of Medical Microbiology, Amsterdam UMC, University of AmsterdamDepartment of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of AmsterdamAbstract Objectives 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. Methods 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s13756-020-0689-xAntimicrobialsAntibiotic stewardshipInappropriate prescribingHospital outpatient clinics |
| spellingShingle | Annemieke K. van den Broek Reinier M. van Hest Kamilla D. Lettinga Afra Jimmink Fanny N. Lauw Caroline E. Visser Jan M. Prins The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands Antimicrobial Resistance and Infection Control Antimicrobials Antibiotic stewardship Inappropriate prescribing Hospital outpatient clinics |
| title | The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands |
| title_full | The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands |
| title_fullStr | The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands |
| title_full_unstemmed | The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands |
| title_short | The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands |
| title_sort | appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the netherlands |
| topic | Antimicrobials Antibiotic stewardship Inappropriate prescribing Hospital outpatient clinics |
| url | http://link.springer.com/article/10.1186/s13756-020-0689-x |
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