Role of Prospective Audit in Antimicrobial Stewardship at the Surgery Department of a Tertiary Hospital in Lagos

Abstract

Background: Prospective audit with intervention and feedback is one of the core strategies of antimicrobial stewardship. Goal is to  preserve the current and future antibiotics against the threat of antimicrobial resistance, while improving patient safety and reducing  healthcare costs. 

Objective: To perform a prospective audit of antimicrobial prescription and feedback as an antimicrobial stewardship  strategy. 

Methodology: This audit was carried out in the Department of Surgery of a Teaching Hospital. Data were gathered from  patients’ clinical records. Each filled checklist was analyzed, and recommendations given based on the antibiotic guidelines. These  recommendations were communicated to the prescriber(s) through the head of the antimicrobial stewardship committee in surgery  department. Compliance to recommendations and reasons for non-compliance were noted. 

Results: Of 655 prescriptions audited, 133  (20%) were for surgical prophylaxis, while 522 (80%) were for treatment. Community acquired infections accounted for 464 (89%) of the treatment while those acquired in the hospital were 58 (11%). Reasons for antibiotic were documented for 522 (80%), sample collection  before antibiotics administration in 56 patients (21%) of which 32 (57%) antibiotics were de-escalated based on laboratory results. Stop/ review dates were indicated only in 77 (15%) of the treatment prescriptions. Appropriate prescribing was observed in 323 (49%) of 655  prescriptions (53 of 133 antibiotics for surgical prophylaxis and 270 of 522 for treatment). 

Conclusion: The compliance rate to the  consensual antibiotic guidelines is still below average. The areas of inappropriateness included wrong choice of antibiotic, prolonged use,  too many antibiotics. Engaging the prescribers to identify the reasons for noncompliance with the guidelines is crucial to improve  appropriate antibiotic prescribing.