Antimicrobial use at a university hospital: appropriate or misused? A qualitative study

• DOI: 10.5414/cpp45169
• Publication Date: 2011-03-25T04:06:17Z
• Authors: V. Vlahovic-Palce...; I. Francetic; G. Palcevski; S. Novak; M. Abram; U. Bergman
• Keywords: Adult; Hospitals, University; 03 medical and health sciences; 0302 clinical medicine; Anti-Infective Agents; antimicrobial use; quality; hospital; Kunin's quality criteria; Croatia; Humans; Bacterial Infections; Drug Utilization; 3. Good health

To evaluate the quality of antimicrobial drug use in a university hospital medical department (Department of Medicine, University Hospital Rijeka, Croatia) with 279 hospital-beds in wards containing patients from endocrinology, gastroenterology, hematology, clinical immunology, cardiology and coronary care unit, nephrology and pulmonology sections of the hospital.The appropriateness of antimicrobial treatment for all in-patients in the Department of Medicine was assessed in a prospective, longitudinal survey carried out during a 21-week period using Kunin's criteria where Categories I and II indicate "appropriate therapy", Categories III and IV indicate major deficiency in the choice or use of antimicrobials. Category V indicates unjustified antimicrobial administration.During the study period, a total of 438 patients were treated with antimicrobials in the Department of Medicine. Of these, 159 (36%) received antimicrobials appropriately (Category I and II), 180 (41%) needed antimicrobials (Category III and IV) but they should have been prescribed differently. The main reason for inappropriate antimicrobial treatment was the wrong choice of antimicrobials (broad-spectrum where a narrow spectrum antibiotic would have been sufficient). In the case of 99 patients (23%) an indication for antimicrobial therapy did not exist (Category V).The main reason for suboptimal use of antimicrobials was the over-prescribing of broad-spectrum antimicrobials. This situation should be corrected e.g. by changes in the post-graduate medical teaching program.