Topical antimicrobial prescribing patterns in residents of Australian aged-care facilities: use of a national point prevalence survey to identify opportunities for quality improvement

Background: Australian residential aged care facilities (RACFs) are encouraged to participate in an annual Aged Care National Antimicrobial Prescribing Survey. This data source was analysed to describe patterns of topical antimicrobial prescribing and thereby provide insight into antimicrobial stewardship (AMS) changes that might be required. Methods: 2018 and 2019 survey data was analysed. Results: The overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed 1 or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899), 33.0% were for topical application. Most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and antibac-terials chloramphenicol (64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the 2 most common indications. Topical antimicrobials were sometimes prescribed for pro re nata administration (38.8%) and greater than 6 months (11.3%). The review or stop date was not always documented (38.7%). Conclusions: To reduce the possibility of adverse consequences associated with antimicrobial use, antimicro-bial stewardship programs in Australian residential aged care facilities should at least ensure mupirocin is appropriately used, first line antimicrobial therapy is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if necessary, pro re nata orders for prescriptions are discouraged and to avoid prolonged duration of prescriptions, review or stop dates are always documented. Crown Copyright (c) 2021 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Automated summary

The study analyzed the patterns of topical antimicrobial prescribing in Australian residential aged care facilities and found that a significant proportion of elderly patients were prescribed topical antimicrobials, with antifungals and antibiotics being the most commonly prescribed. Recommendations for antimicrobial stewardship programs in aged care facilities include appropriate use of mupirocin, prescribing first-line antimicrobial therapy for fungal infections, limiting chloramphenicol use for conjunctivitis, discouraging pro re nata orders, and ensuring review or stop dates are documented to avoid prolonged prescriptions.