Local surveillance of antimicrobial use: framework for Antimicrobial Management Teams

Background

An essential component of antimicrobial stewardship programmes is surveillance of antimicrobial use. At local level, surveillance of antimicrobial use enables the Antimicrobial Management Team (AMT) to plan, prioritise and evaluate the impact of stewardship interventions. Feedback of surveillance data to clinicians in hospital and primary care supports better informed clinical decisions to ensure better patient outcomes. SAPG has developed this framework to support AMTs with local surveillance of antimicrobial use. To facilitate engagement with primary care clinicians, AMTs should liaise with local prescribing support teams.

Antibiotic use measures within National Services Scotland (NSS) Discovery

NSS Discovery is an information system that provides approved users with access to comparative healthcare information to support performance and quality improvement in across NHS Scotland. Discovery contains measures on antimicrobial use (updated quarterly) as part of an Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) dashboard. The following antimicrobial use measures are available at NHS board level:

  • Total antibiotic use in humans expressed as defined daily dose (DDD) per 1,000 inhabitants per day
  • The following measures are presented at NHS board, Health and Social Care Partnership and GP cluster level (excluding dental GP14 prescriptions)
    • Primary care (excluding dental) antibiotic use expressed as items per 1,000 inhabitants per day
    • Primary care (excluding dental) five-day courses as percentage of all courses for amoxicillin 500mg capsules
    • Primary care use of broad-spectrum antibiotics (cephalosporins, clarithromycin, co-amoxiclav, co-trimoxazole, doxycycline and fluoroquinolones) expressed as items per 1,000 inhabitants per day and percentage of total antibiotic items
    • Primary care use of World Health Organisation (WHO) Access antibiotics (modified for UK) expressed as percentage of total antibiotic items

  • The following measures are presented at NHS board and acute hospital level:
    • ​Acute hospital total use of antibiotics expressed as DDDs per 1,000 bed days
    • Acute hospital use of broad-spectrum antibiotics (aztreonam, carbapenems, cephalosporins, ciprofloxacin, clarithromycin, clindamycin, co-amoxiclav, cotrimoxazole, doxycycline, fluoroquinolones, gentamicin, levofloxacin, metronidazole, piperacillin/tazobactam, temocillin and vancomycin intravenous (IV)) expressed as DDDs per 1,000 bed days and percentage of total antibiotic DDDs
    • Acute hospital use of WHO Access antibiotics (modified for UK) expressed as percentage of total antibiotic DDDs
    • IV antibiotics in secondary care expressed as IV DDDs per 1,000 inhabitants per day

AMTs should monitor and discuss antimicrobial use measures in Discovery on a quarterly basis.

Primary care antibiotic use

GP practices receive feedback reports by NHS NSS showing their practice data compared to NHS board and national benchmarks (25th percentile). Medicines Management Teams should use these reports as a focus for discussion of antimicrobial prescribing with GP practices and to identify areas for improvement.

Acute hospital antibiotic use

Local surveillance of acute hospital antibiotic use should also use data obtained from pharmacy stock management system to monitor use of antibiotics. Focus should be on wards or in clinical settings with high volume of antibiotic use, resistant infections, or where lower quality antibiotics prescribing is identified. This should be extended to include use of antifungals in intensive care units and haematology and oncology units to support antifungal stewardship.

AMTs should consider regular whole hospital or targeted point prevalence surveys to support quality improvement and complement the quantitative surveillance of antimicrobial use.

Hospital Electronic Prescribing and Medicines Administration (HEPMA), where available, can also be used to monitor usage, prescribing and administration of antibiotics.

 

                                                                                                         Guidance developed in collaboration with Antimicrobial Resistance and Healthcare Associated infection (ARHAI) Scotland

Scottish Antimicrobial Prescribing Group (SAPG) | April 2024 for review April 2027
Content updated: April 2024