Antimicrobial use in the 2012 PPS

1. Antimicrobial use in the2012 PPS 3rd May 2012 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. 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: YsbytyGlan 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. 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: YsbytyGlan 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

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.

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