Antibiotic Audit

Antibiotic Audit

Nûr-al-ayn Nisar, Sarfraz Makda, Dr Rekash Inamdar University of Leicester, Oakmeadow Surgery

The Problem

Antibiotic Resistance :

• Antibiotic resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them.
• Antibiotics should not be used to treat trivial conditions, because it increases the likelihood of them becoming ineffective for treating more serious conditions
• The overuse of antibiotics in recent years means they're becoming less effective and has led to the emergence of "superbugs". These are strains of bacteria that have developed resistance to many different types of antibiotics, including MRSA and C. difficile.

Background

AMR (antmicrobial resistant) infections are estimated to cause 700,000 deaths each year globally and predicted to rise to 10 million by 2050 if no action is taken. The impacts of leaving AMR unchecked is extremely costly, not only in financial terms but also in terms of global health, food sustainability and security, environmental wellbeing, and socio-economic development. The covid-19 pandemic proved that organisms respect no borders, neither geographical nor ecological and their resistance genes can easily spread causing suffering and death.

Method

How I found the relevant data and interpreted it

Inclusion/Exclusion Criteria

Indicated or Not?

I then entered the patients age, gender, prescribing doctor and indication for antibiotic and whether I thought it was correctly prescribed into a Word Document. All patient data was anonymised and I used LMSG guidelines to help me decide if the antibiotic was correctly prescribed

I I included all patients prescribed co-amoxiclav, ceftriaxone and a quinolone from 1st January 2022 to 28th February 2022. This was to give me a large enough sample size to have meaningful data but not too many patients that I would be unable to complete my audit on time.

Data Collection

I I used SystemOne to look at relevant patient records and see why they had been prescribed the antibiotic of choice. I also used it to access microbiology results to see if the causative organisms were sensitive to the antibiotic prescribed etc.

Recommendations

After this I converted the data into pie charts etc and came up with some recommendations to aid better practice and antimicrobial stewardship

Standard Setting Standards are set at 100%. The aim is for the proportion of co-amoxiclav, cephalosporins and quinolone items as a percentage of all antibiotics to be at or below 10%.

AIM : 10% or below

NOW TIME FOR THE DATA!

Co-amoxiclav

Co-amoxiclav

no. times inappropriately prescribed/no.ptx seen by that specific doctor

Cephalosporins

All indicated and appropriately prescribed

Quinolones

Quinolones

Total inappropriately prescribed: 3/12 = 25% Whilst Dr Lamlilass and other/locum doctors scored the highest there it is important to note that they only saw one patient each so that skews the percentages.

Recommendations

• Review any patient requiring two or more rescue packs in a year as per LMSG guidelines as many of the instances of inappropriately prescribed co-amoxiclav were due to exacerbations of COPD in patients who required a review and were not given one. I would also recommend doing a sputum culture to see whether it is sensitive to amoxicillin as per guidelines. • When prescribing co-amoxiclav for UTIs, try using nitrofurantoin or trimethoprim which are the first line in the guidelines and are also coming up as sensitive in the urine analysis. • To carry on as is best practice for cephalosporins as they were all correctly prescribed.

•• To be more cautious when prescribing antibiotics as in one instance a doctor documented conservative management in a patient who was systemically well with suspected uncomplicated diverticulitis, however, antibiotics were still prescribed. • Signpost new locums to the LMSG antimicrobial guidelines to avoid any confusion and to better integrate them into practice. • Discuss results at next practice meeting and re-audit in 6 months to see if we have achieved a standard of 100%

Conclusions

In conclusion, antimicrobial stewardship is extremely important and everybody in the practice contributes to maintaining this. We can see from the results that the people who score the highest for inappropriate prescription are the locum doctors, which is understandable as they are new to the practice and may not be aware of guidelines or how to use them or access them. Therefore, in the future, it would be important to have a better induction to integrate them into the practice so that everyone can work together towards the goal of better antimicrobial stewardship.

Thank you for listening!