Abstract：
BACKGROUND: Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice.
METHODS: A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness.
RESULTS: From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350).
CONCLUSIONS: As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.
METHODS: A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness.
RESULTS: From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350).
CONCLUSIONS: As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.
摘要：
背景：皮肤和软组织感染（STTI）是医院抗菌药物处方中最常见的适应症之一。不适当的抗菌药物使用会导致发病率增加，不必要的医院再入院和增加抗菌素耐药性。本研究旨在评估澳大利亚医院SSTI管理中抗菌药物处方的质量，为未来的实践提供指导。
方法：对来自全国抗菌药物处方调查（NAPS）的数据进行回顾性分析。分析了来自医院NAPS（2013-2022）的SSTI处方数据和来自手术NAPS（2016-2022）数据集的手术部位感染数据。评估的变量包括指导方针合规性，根据结构化NAPS算法的适当性和不适当的原因。
结果：来自医院NAPS数据集，分析了40,535种SSTI的抗菌处方。最常见的适应症是蜂窝织炎（34.1％；n=13,822），处方最多的抗菌药物是氟氯西林(18.8%；n=7,638)。SSTI适应症的指南依从性较低，但与所有其他抗菌药物处方适应症相比，适当性率更高(指南依从性66.3%，n=21,035vs67.4%，n=156,285适当性75.6%，n=30,639vs72.7%，n=209,383）。不适当的最常见原因是剂量或频率不正确（29.3％；n=2,367）。从外科NAPS数据集中，分析了5,674例手术部位感染的处方。68.2%(n=3,867)被认为是合适的。不适当的最常见原因是剂量或频率不正确（27.7％；n=350）。
结论：由于SSTI是澳大利亚医院处方抗菌药物的常见适应症，因此,建议确定有效的抗菌药物管理策略,以优化SSTI管理的抗菌药物使用,从而改善患者预后.
方法：对来自全国抗菌药物处方调查（NAPS）的数据进行回顾性分析。分析了来自医院NAPS（2013-2022）的SSTI处方数据和来自手术NAPS（2016-2022）数据集的手术部位感染数据。评估的变量包括指导方针合规性，根据结构化NAPS算法的适当性和不适当的原因。
结果：来自医院NAPS数据集，分析了40,535种SSTI的抗菌处方。最常见的适应症是蜂窝织炎（34.1％；n=13,822），处方最多的抗菌药物是氟氯西林(18.8%；n=7,638)。SSTI适应症的指南依从性较低，但与所有其他抗菌药物处方适应症相比，适当性率更高(指南依从性66.3%，n=21,035vs67.4%，n=156,285适当性75.6%，n=30,639vs72.7%，n=209,383）。不适当的最常见原因是剂量或频率不正确（29.3％；n=2,367）。从外科NAPS数据集中，分析了5,674例手术部位感染的处方。68.2%(n=3,867)被认为是合适的。不适当的最常见原因是剂量或频率不正确（27.7％；n=350）。
结论：由于SSTI是澳大利亚医院处方抗菌药物的常见适应症，因此,建议确定有效的抗菌药物管理策略,以优化SSTI管理的抗菌药物使用,从而改善患者预后.
