Abstract：
BACKGROUND: Metronidazole is a commonly prescribed antimicrobial in Australian hospitals. Inappropriate use may increase risks to patient care, such as toxicities and antimicrobial resistance. To date, there is limited information on the quality of metronidazole prescriptions to inform antimicrobial stewardship and quality improvement initiatives. This study aims to describe the quality of metronidazole prescribing practices in Australian hospitals.
METHODS: Retrospective data analysis of the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS). Data were collected by auditors at each participating hospital using a standardised auditing tool. All data from 2013 to 2021 were de-identified and analysed descriptively. Variables included were antimicrobial prescribed, indication, guideline compliance and appropriateness.
RESULTS: Metronidazole was the fifth most prescribed antimicrobial in the Hospital NAPS dataset (2013-2021), accounting for 5.7 % (n = 14,197) of all antimicrobial prescriptions (n = 250,863). The proportion of metronidazole prescriptions declined by 2 % from 2013 to 2021 (p < 0.001). The most common indications were surgical prophylaxis (15.3 %), diverticulitis (9.4 %), aspiration pneumonia (7.3 %). Over half (53.5 %) of metronidazole prescriptions were deemed compliant with prescribing guidelines and 67.8 % were deemed appropriate. These rates were comparatively lower than the overall results of all antimicrobials. The primary documented reason for inappropriateness was that the spectrum was too broad (34.2 %). Surgical prophylaxis had the lowest rates of guideline compliance (53.8 %) and appropriateness (54.3 %).
CONCLUSIONS: Metronidazole remains widely used in Australian hospitals with suboptimal rates of guideline compliance and appropriateness. A noted area for improvement that we identified was using metronidazole when its spectrum was too broad, possibly when anaerobic therapy is unnecessary. With increasing international adoption of the Hospital NAPS programme, future comparative studies will be critical to identify global trends of antimicrobial prescribing quality. Antimicrobial stewardship (AMS) programmes have proven to be effective in improving prescribing quality and should be considered to specifically target improvements in metronidazole prescribing.
METHODS: Retrospective data analysis of the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS). Data were collected by auditors at each participating hospital using a standardised auditing tool. All data from 2013 to 2021 were de-identified and analysed descriptively. Variables included were antimicrobial prescribed, indication, guideline compliance and appropriateness.
RESULTS: Metronidazole was the fifth most prescribed antimicrobial in the Hospital NAPS dataset (2013-2021), accounting for 5.7 % (n = 14,197) of all antimicrobial prescriptions (n = 250,863). The proportion of metronidazole prescriptions declined by 2 % from 2013 to 2021 (p < 0.001). The most common indications were surgical prophylaxis (15.3 %), diverticulitis (9.4 %), aspiration pneumonia (7.3 %). Over half (53.5 %) of metronidazole prescriptions were deemed compliant with prescribing guidelines and 67.8 % were deemed appropriate. These rates were comparatively lower than the overall results of all antimicrobials. The primary documented reason for inappropriateness was that the spectrum was too broad (34.2 %). Surgical prophylaxis had the lowest rates of guideline compliance (53.8 %) and appropriateness (54.3 %).
CONCLUSIONS: Metronidazole remains widely used in Australian hospitals with suboptimal rates of guideline compliance and appropriateness. A noted area for improvement that we identified was using metronidazole when its spectrum was too broad, possibly when anaerobic therapy is unnecessary. With increasing international adoption of the Hospital NAPS programme, future comparative studies will be critical to identify global trends of antimicrobial prescribing quality. Antimicrobial stewardship (AMS) programmes have proven to be effective in improving prescribing quality and should be considered to specifically target improvements in metronidazole prescribing.
摘要：
背景：甲硝唑是澳大利亚医院常用的抗菌药物。不当使用可能会增加患者护理的风险，如毒性和抗菌素耐药性。迄今为止,关于甲硝唑处方质量的信息有限，无法为抗菌药物管理和质量改进举措提供信息。这项研究旨在描述澳大利亚医院中甲硝唑处方的质量。
方法：医院全国抗菌药物处方调查（医院NAPS）的回顾性数据分析。数据是由每个参与医院的审计师使用标准化的审核工具收集的。2013年至2021年的所有数据都被去识别和描述性分析。包括的变量是处方抗菌药物，指示,指导方针的合规性和适当性。
结果：甲硝唑是医院NAPS数据集（2013-2021年）中第五大处方抗菌药物，占所有抗菌药物处方(n=250,863)的5.7%(n=14,197)。2013年至2021年，甲硝唑处方比例下降了2%(p<0.001)。最常见的适应症是手术预防（15.3％），憩室炎（9.4%），吸入性肺炎(7.3%)。超过一半（53.5%）的甲硝唑处方被认为符合处方指南，67.8%被认为是合适的。这些比率相对低于所有抗菌剂的总体结果。不适当的主要记录原因是频谱太宽（34.2％）。手术预防的指南依从性（53.8％）和适当性（54.3％）最低。
结论：甲硝唑在澳大利亚医院中仍然广泛使用，指南依从性和适当性均不理想。我们确定的一个值得注意的改进领域是使用甲硝唑时，它的频谱太宽，可能是在不需要厌氧治疗的时候.随着国际上越来越多地采用医院NAPS计划，未来的比较研究对于确定抗菌药物处方质量的全球趋势至关重要.抗菌药物管理（AMS）计划已被证明可有效提高处方质量，应考虑专门针对甲硝唑处方的改善。
方法：医院全国抗菌药物处方调查（医院NAPS）的回顾性数据分析。数据是由每个参与医院的审计师使用标准化的审核工具收集的。2013年至2021年的所有数据都被去识别和描述性分析。包括的变量是处方抗菌药物，指示,指导方针的合规性和适当性。
结果：甲硝唑是医院NAPS数据集（2013-2021年）中第五大处方抗菌药物，占所有抗菌药物处方(n=250,863)的5.7%(n=14,197)。2013年至2021年，甲硝唑处方比例下降了2%(p<0.001)。最常见的适应症是手术预防（15.3％），憩室炎（9.4%），吸入性肺炎(7.3%)。超过一半（53.5%）的甲硝唑处方被认为符合处方指南，67.8%被认为是合适的。这些比率相对低于所有抗菌剂的总体结果。不适当的主要记录原因是频谱太宽（34.2％）。手术预防的指南依从性（53.8％）和适当性（54.3％）最低。
结论：甲硝唑在澳大利亚医院中仍然广泛使用，指南依从性和适当性均不理想。我们确定的一个值得注意的改进领域是使用甲硝唑时，它的频谱太宽，可能是在不需要厌氧治疗的时候.随着国际上越来越多地采用医院NAPS计划，未来的比较研究对于确定抗菌药物处方质量的全球趋势至关重要.抗菌药物管理（AMS）计划已被证明可有效提高处方质量，应考虑专门针对甲硝唑处方的改善。
