• Neil Powell, Kate McGraw-Allen, Alasdair Menzies, Bradley Peet, Callie Simmonds, and Abigail Wild.
• Royal Cornwall Hospitals NHS Trust, Truro, UK and National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in healthcare associated infections and antimicrobial resistance at Imperial College London in partnership with Public Health England (PHE), London, UK neil.powell2@nhs.net.
• Clin Med (Lond). 2018 Aug 1; 18 (4): 276281276-281.

AbstractEvidence-based audit tools were used to identify the antibiotic stewardship improvements necessary to meet the NHS England targets in a 750-bed teaching hospital.Antibiotic prescribing was reviewed against published evidence-based audit tools for 139 patients treated with antibiotics. Severe community-acquired pneumonia (CAP) median course length was 8.5 days. Ninety-six percent of non-severe CAP patients were initiated on intravenous antibiotics (IV); median antibiotic course length 9 days. Twenty-six percent of urinary tract infection (UTI) patients without an indwelling catheter met the UTI diagnostic criteria. IV antibiotics initiated in 79% patients with other infections. Of these, 17% met the IV to oral switch criteria at 72 hours but were not switched. On average, antibiotic courses were 19% longer than recommended. Three key areas for improvement consist of: (a) implement the National Institute of Health and Care Excellence UTI Quality Standard - only 38% of patients treated for UTI met the UTI definition; (b) ensure antibiotic course lengths are in line with local prescribing guidelines - antibiotics were continued for 14% longer than recommended in local guidelines; (c) switch antibiotic therapy to oral when switch criteria met - 17% percent of patients initiated on IV antibiotics were eligible for oral switch by 72 hours and were not switched.© Royal College of Physicians 2018. All rights reserved.

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