The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data

BackgroundSkin 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 readmission and increased antimicrobial resistance. This study aims to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice.MethodsA 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.ResultsFrom 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 to 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=2,367). From the Surgical NAPS dataset, 5,674 prescriptions for surgical site infections were analysed. 68.2% (n=3,867) were deemed appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%; n=350).ConclusionsAs SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimise antimicrobial use for SSTI management is therefore recommended to improve patient outcomes. 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 readmission and increased antimicrobial resistance. This study aims to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice. 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. 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 to 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=2,367). From the Surgical NAPS dataset, 5,674 prescriptions for surgical site infections were analysed. 68.2% (n=3,867) were deemed appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%; n=350). As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimise antimicrobial use for SSTI management is therefore recommended to improve patient outcomes.