engleski

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

Objective: To evaluate the quality of antimicrobial drug use at the Department of Medicine with 270 patient beds at the University Hospital Rijeka, Croatia. Methods: The appropriateness of antimicrobial treatment was assessed in a prospective, longitudinal survey, during a 21-week period using modified Kunin's criteria. Criteria were categorized as follows: I. Agree with the use of antimicrobial therapy, the protocol is appropriate ; II. Agree with the use of antimicrobial therapy, the protocol is probably appropriate ; III. Agree with the use of antimicrobial therapy, but a different antimicrobial is preferred ; IV. Agree with the use of antimicrobial therapy but a different mode of use is preferred ; and V. Disagree with the use of antimicrobial therapy, administration is unjustified. Categories I. and II. indicate "appropriate therapy", categories III. and IV. indicate some major deficiency in the choice or use of antimicrobials. Results: During the study period 438 patients were treated with antimicrobials at the Department of Medicine. Of these, 159 (36%) had 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 inapproprite antimicrobial treatment was the wrong choice of animicrobials (broad-spectrum where a narrow spectrum would suffice). Ninty-nine patients (23%) did not need antimicrobials at all (category V). Conclusion: The main reason for suboptimal use of antimicrobials was over- prescribing of broad-spectrum antimicrobials, and its reduction should be a major goal of the stewardship program in the Department of medicine in our institution.

antimicrobial use; quality; hospital; Kunin's quality criteria

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