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Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study.

Charani, E; de Barra, E; Rawson, TM; Gill, D; Gilchrist, M; Naylor, NR; Holmes, AH (2019) Antibiotic prescribing in general medical and surgical specialties: a prospective cohort study. Antimicrob Resist Infect Control, 8. p. 151. ISSN 2047-2994 https://doi.org/10.1186/s13756-019-0603-6
SGUL Authors: Gill, Dipender Preet Singh

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Abstract

Background: Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice. Methods: We prospectively analysed the antibiotic prescribing across general medical and surgical teams for acutely admitted patients. Over a 12-month period (June 2016 - May 2017) 659 patients (362 medical, 297 surgical) were followed for the duration of their hospital stay. Antibiotic prescribing across these cohorts was assessed using Chi-squared or Wilcoxon rank-sum, depending on normality of data. The t-test was used to compare age and length of stay. A logistic regression model was used to predict escalation of antibiotic therapy. Results: Surgical patients were younger (p < 0.001) with lower Charlson Comorbidity Index scores (p < 0.001). Antibiotics were prescribed for 45% (162/362) medical and 55% (164/297) surgical patients. Microbiological results were available for 26% (42/164) medical and 29% (48/162) surgical patients, of which 55% (23/42) and 48% (23/48) were positive respectively. There was no difference in the spectrum of antibiotics prescribed between surgery and medicine (p = 0.507). In surgery antibiotics were 1) prescribed more frequently (p = 0.001); 2) for longer (p = 0.016); 3) more likely to be escalated (p = 0.004); 4) less likely to be compliant with local policy (p < 0.001) than medicine. Conclusions: Across both specialties, microbiology investigation results are not adequately used to diagnose infections and optimise their management. There is significant variation in antibiotic decision-making (including escalation patterns) between general surgical and medical teams. Antibiotic stewardship interventions targeting surgical specialties need to go beyond surgical prophylaxis. It is critical to focus on of review the patients initiated on therapeutic antibiotics in surgical specialties to ensure that escalation and continuation of therapy is justified.

Item Type: Article
Additional Information: © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Antibiotic escalation, Antibiotic-decision making, Surgery, Anti-Bacterial Agents, Antimicrobial Stewardship, Clinical Decision-Making, Drug Prescriptions, Humans, Logistic Models, Practice Patterns, Physicians', Prospective Studies, Specialties, Surgical, Humans, Anti-Bacterial Agents, Logistic Models, Prospective Studies, Specialties, Surgical, Drug Prescriptions, Practice Patterns, Physicians', Clinical Decision-Making, Antimicrobial Stewardship
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Antimicrob Resist Infect Control
ISSN: 2047-2994
Language: eng
Dates:
DateEvent
13 September 2019Published
30 August 2019Accepted
Projects:
Project IDFunderFunder ID
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100004440
ES/P008313/1Economic and Social Research Councilhttp://dx.doi.org/10.13039/501100000269
PubMed ID: 31528337
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112809
Publisher's version: https://doi.org/10.1186/s13756-019-0603-6

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