Antimicrobial stewardship in remote primary healthcare across northern Australia

PeerJ

article

Will Cuningham¹  Lorraine Anderson²  Asha C. Bowen¹  Kirsty Buising⁵  Christine Connors⁷  Kathryn Daveson⁸  Joanna Martin²  Stacey McNamara⁸  Bhavini Patel⁷  Rodney James⁵  John Shanks⁷  Kerr Wright²  Trent Yarwood⁸  Steven YC Tong¹  Jodie McVernon⁵ 

[1] Menzies School of Health Research, Charles Darwin University;Kimberley Aboriginal Medical Services;Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia;Department of Infectious Diseases, Perth Children’s Hospital;The Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne;Victorian Infectious Diseases Service, The Royal Melbourne Hospital;Top End Health Service, NT Department of Health;Queensland Statewide Antimicrobial Stewardship Program, Metro North Hospital and Health Service;Department of Infectious Diseases and Microbiology, Canberra Hospital;Charles Darwin University;Cairns Hospital;Rural Clinical School, University of Queensland;College of Medicine and Dentistry, James Cook University;Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity;Melbourne School of Population and Global Health, The University of Melbourne

关键词: Antimicrobial stewardship;    Remote primary healthcare;    Indigenous Health;    Antimicrobial resistance;    Infectious disease;    Antimicrobial use;   

DOI  :  10.7717/peerj.9409

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

Background The high burden of infectious disease and associated antimicrobial use likely contribute to the emergence of antimicrobial resistance in remote Australian Aboriginal communities. We aimed to develop and apply context-specific tools to audit antimicrobial use in the remote primary healthcare setting. Methods We adapted the General Practice version of the National Antimicrobial Prescribing Survey (GP NAPS) tool to audit antimicrobial use over 2–3 weeks in 15 remote primary healthcare clinics across the Kimberley region of Western Australia (03/2018–06/2018), Top End of the Northern Territory (08/2017–09/2017) and far north Queensland (05/2018–06/2018). At each clinic we reviewed consecutive clinic presentations until 30 presentations where antimicrobials had been used were included in the audit. Data recorded included the antimicrobials used, indications and treating health professional. We assessed the appropriateness of antimicrobial use and functionality of the tool. Results We audited the use of 668 antimicrobials. Skin and soft tissue infections were the dominant treatment indications (WA: 35%; NT: 29%; QLD: 40%). Compared with other settings in Australia, narrow spectrum antimicrobials like benzathine benzylpenicillin were commonly given and the appropriateness of use was high (WA: 91%; NT: 82%; QLD: 65%). While the audit was informative, non-integration with practice software made the process manually intensive. Conclusions Patterns of antimicrobial use in remote primary care are different from other settings in Australia. The adapted GP NAPS tool functioned well in this pilot study and has the potential for integration into clinical care. Regular stewardship audits would be facilitated by improved data extraction systems.

【 授权许可】

CC BY