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Antimicrobial Use at Acute Care Hospitals in Nova Scotia: A Point Prevalence Survey.

Background
Point prevalence surveys are used to monitor antimicrobial use and identify targets for improvement through antimicrobial stewardship activities. Few studies have evaluated antimicrobial use in Nova Scotia acute care institutions.


Objectives
To determine the prevalence and characteristics of antimicrobial use in Nova Scotia hospitals.


Methods
A point prevalence survey was conducted between June and November 2015 for patients admitted to hospitals with at least 30 acute care beds. On each survey day, charts were reviewed to identify patients receiving antimicrobial agents on that day. Data were gathered on the type of antimicrobial agent prescribed, route of administration, intended duration of use, and indication. Adherence to regional and local treatment guidelines was assessed. Results were summarized descriptively. Findings were compared using the Fisher exact test or the Cochran-Armitage trend test.


Results
Twelve of the 13 eligible hospitals participated, and a total of 1499 patient charts were examined. The overall prevalence of antimicrobial use was 30.6% (458/1499). The prevalence of antimicrobial use differed significantly according to area of specialty, with the highest prevalence occurring in intensive care wards (47.2%, 50/106) and surgical wards (43.4%, 179/412), as compared with medical wards (27.9%, 192/687) and "other" specialty wards (11.1%, 32/289) (p < 0.001). Among the 520 indications for antimicrobial use, the most common was respiratory tract infection (81 or 15.6%). In total, 660 antimicrobial agents were prescribed to the 458 patients; a third of these patients (152 or 33.2%) received more than 1 antimicrobial agent. The class of antimicrobials most frequently prescribed was "other beta-lactam antimicrobials" (31.2%, 206/660). The majority of antimicrobials (62.0%, 409/660) were prescribed for administration via the parenteral route. Adherence to regional treatment guidelines was 29.9% (26 of 87 indications analyzed). Documentation of indication was lacking for 104 (20.0%) of the 520 indications, and documentation of the intended duration of antimicrobial use was lacking for 326 (62.7%) of the 520 indications.


Conclusions
Antimicrobial agents were prescribed for about one-third of acute care patients in Nova Scotia. Specific targets for improvement in antimicrobial use include decreases in prescribing of broad-spectrum and parenteral antimicrobials, better adherence to guidelines, and improved documentation. In developing initiatives, antimicrobial stewardship programs in Nova Scotia should focus on identified targets for improvement.