Miss Josephine Wen1,2, Dr Michael Malloy4, Prof Karin Thursky1,2, Dr Rod James1,2, Prof Lisa Hall1,2,3, A/Prof Noleen Bennett1,2,4
1Royal Melbourne Hospital Guidance Group, Melbourne Health, Melbourne, Australia, 2National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Australia, 3School of Public Health, University of Queensland, Brisbane, Australia, 4Victorian Healthcare Associated Infection Surveillance System (VICNISS), Melbourne Health, Melbourne, Australia
Biography:
Josephine is an experienced antimicrobial stewardship pharmacist and project officer at the Royal Melbourne Hospital Guidance Group and National Centre for Antimicrobial Stewardship. She is currently the program manager for the National Antimicrobial Prescribing Survey (NAPS) program.
Abstract:
Introduction
The Aged Care National Antimicrobial Prescribing Survey (Aged Care NAPS) is a national audit program that enables residential aged care homes (RACHs) to monitor infections and antimicrobial use. This study aimed to assess the quality of antimicrobial use in Australian RACHs using Aged Care NAPS data.
Methods
Retrospective analysis of Aged Care NAPS data collected by auditors between 1 January 2020 and 31 December 2024. Guideline concordance was evaluated for the five most common indications, based on Therapeutic Guidelines: Antibiotic 16th edition.
Results
A total of 41,786 prescriptions from 1,372 unique RACHs were audited during the study period. The most common indications for antimicrobial prescribing were cystitis, tinea, non-surgical wound infection, pneumonia, and cellulitis. Incorrect antimicrobial choices were common, such as cefalexin and roxithromycin for pneumonia, and amoxicillin-clavulanic acid and doxycycline for cellulitis. Prevalence of dosing errors ranged from 3.4% (trimethoprim for cystitis) to 78.0% (amoxicillin for pneumonia). Cefalexin was frequently prescribed and commonly incorrectly dosed (70.3% incorrect in cystitis, 72.8% in non-surgical wound infections, 68.2% in cellulitis). Over 40.0% of the prescriptions for the top five antimicrobials for each indication exceeded recommended treatment durations, ranging from 41.7% (amoxicillin for cystitis) to 93.1% (ketoconazole for tinea). Tinea cases often involved antimicrobial use beyond six months and routine pro re nata (PRN) prescribing.
Conclusion
Aged Care NAPS shows promise as a tool for monitoring the quality of antimicrobial prescribing in RACHs. Further research is needed to examine human factors at play, in order to better target antimicrobial stewardship interventions.