Antimicrobial resistance is a major threat to human health. In the OPAT setting broad-spectrum once daily antimicrobials may be chosen in preference to other agents requiring multiple daily doses for reasons of convenience. The role and effectiveness of antimicrobial stewardship (AMS) in the Australian hospital-in-the-home (OPAT) setting have not previously been studied.
The National Antimicrobial Prescribing Survey (NAPS) was developed in 2011 to provide an audit of antimicrobial prescribing in Australian hospitals and is conducted by The Australian National Centre for Antimicrobial Stewardship (NCAS). The Hospital NAPS was modified for the OPAT setting, trialed in 2016 in 5 health services and rolled out to all Australian OPAT services as a pilot in 2017.
Twenty-three OPAT services throughout Australia participated in the OPAT NAPS pilot. In total, 1154 prescriptions for 722 patients (63% male) were included. Patients ranged in age from 1 month to 101 years; median age was 58 years.
The most common indications for parenteral antimicrobials were; cellulitis (30%), osteomyelitis (8%), pneumonia (7%), abscess (6%), Cystic Fibrosis exacerbation (5%), endocarditis (4%), septic arthritis (4%), prosthetic joint infection (4%), and exacerbation of bronchiectasis (2%). Piperacillin-tazobactam or ceftriaxone were prescribed in 20% of cases.
The majority of prescriptions for antimicrobials to treat community-acquired pneumonia and exacerbations of chronic obstructive airways disease were not compliant with guidelines.The median duration of parenteral therapy for cellulitis was 4 days, however, duration ranged overall from 1-44 days for this indication.
Prescriptions were compliant with guidelines in 43% of cases, and appropriateness of antimicrobial prescribing was assessed as optimal in 74%, adequate in 13%, suboptimal in 8.5% and inadequate in 3%. Antimicrobial therapy duration was incorrect in 9% of cases.
Opportunities exist for improving AMS interventions in the OPAT setting, specifically in regards to the use of broad-spectrum antimicrobials and in the treatment of respiratory tract infection. Importantly, not all OPAT services have the same access to AMS.
N. D. Friedman, None