Backgound
Antimicrobial stewardship (AMS) is a continual, systematic effort by health organisations to optimise antimicrobial use among patients ‘to improve patient outcomes, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use.’ One AMS initiative is to measure the volume of antimicrobials used in the health organisation to identify changes and trends in usage. To enable standardised comparison of antimicrobial utilisation between health care facilities, many organisations, including the National Antimicrobial Utilisation Surveillance Program (NAUSP), convert the usage data to World Health Organisation’s defined daily doses (DDD) per 1000 occupied bed days. DDD is an internationally recognised drug usage rate, defined as the assumed average maintenance dose per day for a drug used for its main indication in adults, as the standardised unit of measure. However, in the day hospital oncology setting, certain antimicrobials are used at different dosing regimens for prophylaxis of pneumocystis jiroveci (carinii), herpes simplex virus, varicella zoster virus and fungal infections in higher risk cancer patients. Additionally, the use of occupied bed days as the denominator in standardised usage rate calculations is not applicable to day hospital patients. As such, the standardised antimicrobial usage methodology is skewed and difficult to interpret in this care setting.
Aims
To adjust the DDD for specific antimicrobials to generate more useful antibiotic usage reporting for oncology, day-hospital practice.
To use this data to track prescribing trends in specific patient groups i.e. haematology patients.
Methods
Three-monthly antibiotic usage reports are extracted from patient dispensing data and recalculated, using SAP Business Objects software, into DDD reports per specific antimicrobial agent and per antimicrobial drug class.
Fluconazole, trimethoprim/sulfamethoxazole and valaciclovir DDDs were adjusted based on recommended antifungal and antiviral prophylactic doses and frequency in haematology practice. This data was further compared to haematology patient separations to track trending.
Results & Conclusions
Pending.