Antimicrobial use in the 2012 PPS 3rd May 2012 Antimicrobial use in the 2012 PPS Robin A Howe Antimicrobial use in Primary Care

PPS 2011 Broadly similar to previous surveys of 2008/09/10 Mandated by WG – greater coverage, esp. smaller hospitals Based on ESAC methods New indications, specialties, diagnosis sites

Indications

Specialties

Diagnosis sites Rational Antimicrobial Use

What can we get from the PPS? Understand the pattern of antibiotic use Describe potential measures of quality Identify areas for potential further investigation or improvement

Characterising Antimicrobial Use

2494/9094 (27.4%) receiving an antimicrobial 2008 – 31% 2009 – 29.5% 2010 – 30% 2011 – 30% (antibacterials in 37 comparator hospitals)

AB use - acute hospitals A: Bronglais B: Princess of Wales C: Royal Glamorgan D: Royal Gwent E: Morriston F: UHW G: Withybush H: Wrexham Maelor J: Glangwili K: Ysbyty Gwynedd L: Ysbyty Glan Clwyd M: Nevill Hall N: Prince Charles P: Llandough R: Prince Philip S; Singleton T: Neath Port Talbot AB use - acute hospitals Rational Antimicrobial Use

AB use – acute hospitals A: Bronglais B: Princess of Wales C: Royal Glamorgan D: Royal Gwent E: Morriston F: UHW G: Withybush H: Wrexham Maelor J: Glangwili K: Ysbyty Gwynedd L: Ysbyty Glan Clwyd M: Nevill Hall N: Prince Charles P: Llandough R: Prince Philip S; Singleton T: Neath Port Talbot Rational Antimicrobial Use

Age group & gender of patients prescribed antimicrobials

Indications for antibacterial prescribing by Age Group (%)

Antibacterial prescribing by sector and specialty

Antibacterial prescribing by indication/ specialty in the Acute Sector Rational Antimicrobial Use

Antibacterial prescribing by indication/ hospital in the Acute Sector Rational Antimicrobial Use

Quality measures

Number of antibacterials prescribed per patient by specialty in Acute Sector Rational Antimicrobial Use

Number of antibacterials prescribed per patient by hospital/sector Rational Antimicrobial Use

Antibacterial prescribing by route and specialty in Acute Sector Rational Antimicrobial Use

Antibacterial prescribing by route for acute sector hospitals Rational Antimicrobial Use

Reason for antimicrobial prescription was recorded in notes by sector and specialty (%). Rational Antimicrobial Use

Surgical prophylaxis >1 day by diagnosis group (%) 2008-2010 ENT Rational Antimicrobial Use

Areas for investigation/ improvement

Comparison of top 10 antibacterials for 2010 & 2011 PPS

Diagnoses for piperacillin/tazobactam plus metronidazole prescribing (n=42)

Antibacterial regimens (%) for CA-RTI 2010-2011 High rate of “other” CLA use decreasing DOX increasing PTZ + MTZ increasing

Antibacterial regimens (%) for HA-RTI 2010-2011 Decreasing “other” Increasing PTZ Increasing DOX Decreasing AMO

Antibacterial regimens (%) for CA-UTI 2010-2011 Consistent prescribing Increasing CIP

Antibacterial regimens (%) for HA-Cys 2010-2011 Surprisingly high TMP use

Antibacterial regimens (%) for CA-SSTBJI 2010-2011 V high “others” Significant FLU + PEN

Antibacterial regimens for HA-SSTBJI 55 different regimens ?CHAOTIC?

Clostridium difficile regimens 2010 & 2011 (%) 12% for >10 days (14.3% in 2010) (19.6% in 2009)

Overall 8.8% of patients surveyed were being treated for a hospital acquired infection only, as deemed by the prescriber. Only 4.0% of patients were considered to have a HAI as defined by the HAI case definitions within the survey. This may be in part because the application of the HAI prevalence definitions results in a degree of under-reporting of HAI, but may also confirm that antimicrobials are over prescribed

Conclusions Antibiotic use has not materially changed (~30% in-patients) Use varies across acute sector hospitals (24-41%) Quality measures show variability PO/IV Recording Surgical prophylaxis Areas for study/improvement C. difficile treatment Antimicrobial guidance/adherence Discrepancy between diagnosis and treatment of HAI