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

2. 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

3. Indications

4. Specialties

5. Diagnosis sites
Rational Antimicrobial Use

6. 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

7. Characterising Antimicrobial Use

8. 2494/9094 (27.4%) receiving an antimicrobial
2008 – 31%
2009 – 29.5%
2010 – 30%
2011 – 30% (antibacterials in 37 comparator hospitals)

9. 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

10. 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

11. Age group & gender of patients prescribed antimicrobials

12. Indications for antibacterial prescribing by Age Group (%)

13. Antibacterial prescribing by sector and specialty

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

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

16. Quality measures

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

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

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

20. Antibacterial prescribing by route for acute sector hospitals
Rational Antimicrobial Use

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

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

23. Areas for investigation/ improvement

24. Comparison of top 10 antibacterials for 2010 & 2011 PPS

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

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

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

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

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

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

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

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

34. 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

36. 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