Topical antimicrobial prescribing patterns in residents of Australian aged-care facilities: use of a national point prevalence survey to identify opportunities for quality improvement

Noleen Bennett; Katherine Walker; Kirsty Buising; Ron Cheah; Xin Fang; Robyn Ingram; Rodney James; Michael J Malloy; Karin Thursky; Leon J Worth

doi:10.1016/j.ajic.2021.03.019

Topical antimicrobial prescribing patterns in residents of Australian aged-care facilities: use of a national point prevalence survey to identify opportunities for quality improvement

Am J Infect Control. 2021 Sep;49(9):1113-1117. doi: 10.1016/j.ajic.2021.03.019. Epub 2021 Apr 1.

Authors

Noleen Bennett¹, Katherine Walker², Kirsty Buising³, Ron Cheah⁴, Xin Fang⁴, Robyn Ingram⁴, Rodney James⁵, Michael J Malloy⁶, Karin Thursky⁷, Leon J Worth⁸

Affiliations

¹ National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: Noleen.Bennett@mh.org.au.
² Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
³ National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁴ National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
⁵ National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁷ National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.
⁸ Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia.

PMID: 33813041
DOI: 10.1016/j.ajic.2021.03.019

Abstract

Background: Australian residential aged care facilities (RACFs) are encouraged to participate in an annual Aged Care National Antimicrobial Prescribing Survey. This data source was analysed to describe patterns of topical antimicrobial prescribing and thereby provide insight into antimicrobial stewardship (AMS) changes that might be required.

Methods: 2018 and 2019 survey data was analysed.

Results: The overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed 1 or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899), 33.0% were for topical application. Most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and antibacterials chloramphenicol (64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the 2 most common indications. Topical antimicrobials were sometimes prescribed for pro re nata administration (38.8%) and greater than 6 months (11.3%). The review or stop date was not always documented (38.7%).

Conclusions: To reduce the possibility of adverse consequences associated with antimicrobial use, antimicrobial stewardship programs in Australian residential aged care facilities should at least ensure mupirocin is appropriately used, first line antimicrobial therapy is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if necessary, pro re nata orders for prescriptions are discouraged and to avoid prolonged duration of prescriptions, review or stop dates are always documented.

Keywords: Antimicrobial stewardship; Topical antimicrobial agents.

MeSH terms

Aged
Anti-Bacterial Agents / therapeutic use
Anti-Infective Agents* / therapeutic use
Australia
Humans
Inappropriate Prescribing
Prevalence
Quality Improvement*

Substances

Anti-Bacterial Agents
Anti-Infective Agents