Antimicrobial stewardship in remote primary healthcare across northern Australia

Will Cuningham; Lorraine Anderson; Asha C Bowen; Kirsty Buising; Christine Connors; Kathryn Daveson; Joanna Martin; Stacey McNamara; Bhavini Patel; Rodney James; John Shanks; Kerr Wright; Trent Yarwood; Steven Yc Tong; Jodie McVernon

doi:10.7717/peerj.9409

Antimicrobial stewardship in remote primary healthcare across northern Australia

PeerJ. 2020 Jul 22:8:e9409. doi: 10.7717/peerj.9409. eCollection 2020.

Authors

Will Cuningham¹, Lorraine Anderson², Asha C Bowen^{1

3

4}, Kirsty Buising^{5

6}, Christine Connors⁷, Kathryn Daveson^{8

9}, Joanna Martin², Stacey McNamara⁸, Bhavini Patel^{7

10}, Rodney James⁵, John Shanks⁷, Kerr Wright², Trent Yarwood^{8

11

12

13}, Steven Yc Tong^{1

14}, Jodie McVernon^{5

15}

Affiliations

¹ Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
² Kimberley Aboriginal Medical Services, Kimberley, Western Australia, Australia.
³ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
⁴ Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.
⁵ The Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia.
⁶ Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁷ Top End Health Service, NT Department of Health, Darwin, Northern Territory, Australia.
⁸ Queensland Statewide Antimicrobial Stewardship Program, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
⁹ Department of Infectious Diseases and Microbiology, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
¹⁰ Charles Darwin University, Darwin, Northern Territory, Australia.
¹¹ Cairns Hospital, Cairns, Queensland, Australia.
¹² Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia.
¹³ College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
¹⁴ Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
¹⁵ Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Abstract

Background: The high burden of infectious disease and associated antimicrobial use likely contribute to the emergence of antimicrobial resistance in remote Australian Aboriginal communities. We aimed to develop and apply context-specific tools to audit antimicrobial use in the remote primary healthcare setting.

Methods: We adapted the General Practice version of the National Antimicrobial Prescribing Survey (GP NAPS) tool to audit antimicrobial use over 2-3 weeks in 15 remote primary healthcare clinics across the Kimberley region of Western Australia (03/2018-06/2018), Top End of the Northern Territory (08/2017-09/2017) and far north Queensland (05/2018-06/2018). At each clinic we reviewed consecutive clinic presentations until 30 presentations where antimicrobials had been used were included in the audit. Data recorded included the antimicrobials used, indications and treating health professional. We assessed the appropriateness of antimicrobial use and functionality of the tool.

Results: We audited the use of 668 antimicrobials. Skin and soft tissue infections were the dominant treatment indications (WA: 35%; NT: 29%; QLD: 40%). Compared with other settings in Australia, narrow spectrum antimicrobials like benzathine benzylpenicillin were commonly given and the appropriateness of use was high (WA: 91%; NT: 82%; QLD: 65%). While the audit was informative, non-integration with practice software made the process manually intensive.

Conclusions: Patterns of antimicrobial use in remote primary care are different from other settings in Australia. The adapted GP NAPS tool functioned well in this pilot study and has the potential for integration into clinical care. Regular stewardship audits would be facilitated by improved data extraction systems.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Antimicrobial use; Indigenous Health; Infectious disease; Remote primary healthcare.

Grants and funding

This work was funded by a pilot project grant from the NHMRC-funded HOT NORTH program (GNT1131932). Will Cuningham is supported by an Australian Postgraduate Research Training Program Scholarship. Steven Tong is an Australian National Health and Medical Research Council Career Development Fellow (GNT1145033). Jodie McVernon is an Australian National Health and Medical Research Council Principal Research Fellow (GNT1117140). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.