BACKGROUND AND OBJECTIVES:While microbiology tests can guide management of infectious diseases, little is known about the prevalence of testing around the time of antibiotic initiation in long-term care facilities (LTCFs). The objectives of this study were to investigate prevalence and factors associated with microbiology testing around the time of antibiotic initiation, and subsequent treatment pathways in LTCFs. METHODS:This retrospective cohort study included individuals aged ≥65 years who entered a LTCF in three Australian states between 1 January 2017 and 30 June 2019, and received a systemic antibiotic (n = 36 977). Prevalence of microbiology testing in the 14 days pre- and 7 days post-antibiotic initiation, and treatment pathways 14 days post-initiation, were determined. Multivariable logistic regression determined adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs) for factors associated with testing. RESULTS:In total 15 407 (41.7%) individuals were tested around the time of antibiotic initiation, ranging from 22.9% (n = 585/2551 residents) of macrolide initiators to 79.3% (n = 413/521) of nitrofurantoin initiators. Individuals with urinary tract infections on LTCF entry (aOR 1.24, 95%CI 1.10-1.40) or initiating trimethoprim (aOR 2.80, 95%CI 2.50-3.13) were more likely to be tested. Males (aOR 0.81, 95%CI 0.77-0.85), and residents who received cephalosporins (aOR 0.75, 95%CI 0.68-0.84), penicillins (aOR 0.49, 95%CI 0.45-0.55), or with airways disease (aOR 0.87, 95%CI 0.82-0.91) had lower odds of testing. Among those tested, 14.5% (n = 2238) had a second dispensing of the same antibiotic, 11.4% (n = 1 751) switched antibiotic therapy and 5.9% (n = 904) were hospitalized within 14 days. CONCLUSIONS:With four in ten residents tested, and lower prevalence within certain resident subgroups, this study suggests a high dependence on initiating empiric therapy in LTCFs.

The emergence and spread of antimicrobial-resistant organisms is a major global health challenge. We report on the approach and outcomes of a programme which aimed to take a One Health approach, incorporating an understanding that the health of humans, animals and the environment are linked. Combating the Threat of Antimicrobial Resistance in Pacific Island Countries (COMBAT-AMR) was funded by the Australian Department of Foreign Trade and designed to build capacity across human and animal health to address the threat of antimicrobial resistance (AMR) in Fiji, Samoa, Papua New Guinea and the Solomon Islands between 2020 and 2023.Semi-structured interviews were undertaken with implementers, key stakeholders and participants across the programme themes (n=53). Evaluation of specific activities included participant surveys, competency assessments and document reviews.Both the human health and animal health sectors made significant progress in capacity-building and mentoring of local staff and collection and analysis of surveillance data. However, the sectors largely operated in parallel, with limited planning or resources allocated for explicit intersectoral activities. Resources allocated to animal health were also insufficient to compensate for under-resourced animal health sectors in comparison to human health sectors in the target countries.The increasing use of One Health approaches to address AMR necessitates careful consideration of strategies to support intersectoral collaboration at the design and implementation stages. The comprehensive evaluation of the COMBAT-AMR programme contributes to the current evidence base regarding operationalising One Health principles in building capacity in AMR in low- and middle-income countries.

The objective of this study is to determine whether primary care electronic health record (EHR) data are sufficiently complete and plausible to support automated audits of antimicrobial prescribing quality.Cross-sectional descriptive assessment of antimicrobial auditing-related fields in Patron, a large Australian primary care EHR dataset with 3.5 million patients from 129 consenting general practices. Data from 2018 to 2022 were evaluated using the Harmonized Data Quality Assessment Terminology and Framework, covering conformance, completeness, and plausibility.Thirty-one fields (137,776,804 rows; 1,406,364 patients across 116 practices) were assessed. Value conformance and plausibility were high for most core audit variables, including demographics, antimicrobial name, dose, allergy status, and visit date. Prescribing indication was incompletely captured (13-27% completeness), and allergy severity was recorded in 26% of allergy entries. Vendor-level heterogeneity contributed substantially to variation in field completeness.Australian primary care EHR data capture the core structured elements required for automated antimicrobial prescribing audits, enabling assessments of spectrum suitability, microbiology mismatch, and prescribing prevalence. Incomplete and inconsistent documentation of indication and allergy severity necessitates the use of proxy fields or inference for more complex evaluations. Greater standardization across EHR systems is required to enhance the scalability and clinical utility of automated audits in primary care.

Background: There is increasing awareness of the importance of antimicrobial stewardship in long-term care settings internationally. Despite this, there is little robust surveillance data on the quality of prescribing in this setting to help target interventions. In Australia, nursing homes are known as residential aged care homes (RACHs). The Aged Care National Antimicrobial Prescribing Survey (Aged Care NAPS) is a national, standardized audit program enabling Australian RACHs to monitor antimicrobial use and provide feedback on prescribing practices. Since 2016, the program has collected detailed prescribing data but has not made an explicit assessment on prescribing quality. With revision to Australian national prescribing guidelines, we now have the potential to use this data to assess concordance with guidelines. Methods: All Australian RACHs are eligible and invited annually to participate in the Aged Care NAPS. A single-day point prevalence audit is the primary methodology adopted. Antimicrobial prescribing data are collected by auditors at participating RACHs and entered into an online platform. All residents present on the survey day were included in the audit. Retrospective analysis of Aged Care NAPS data collected between 1 January 2020 and 31 December 2024 was undertaken. Guideline concordance was evaluated for the five most common indications (cystitis, tinea, non-surgical wound infection, pneumonia and cellulitis), using the Therapeutic Guidelines: Antibiotic 16th edition and Dermatology 4th and 5th editions. Results: A total of 41,786 prescriptions from 1,408 RACHs were audited during the study period. The five most common indications accounted for 37.4% of all prescriptions. Incorrect antimicrobial choices were common, such as cefalexin and roxithromycin for pneumonia, and amoxicillin-clavulanic acid and doxycycline for cellulitis. Prevalence of dosing errors ranged from 3.4% (trimethoprim for cystitis) to 78.0% (amoxicillin for pneumonia). Cefalexin was frequently prescribed and commonly incorrectly dosed (70.3% in cystitis, 72.8% in non-surgical wound infections, 68.2% in cellulitis). Over 40% of prescriptions for the top five antimicrobials for each indication exceeded recommended treatment durations, ranging from 41.7% (amoxicillin for cystitis) to 96.8% (ketoconazole for tinea). Prescribing for tinea often exceeded six months and included non-recommended pro re nata (PRN) prescriptions. Conclusion: The Aged Care NAPS shows promise as a tool to monitor the quality of antimicrobial prescribing in long-term care facilities. This analysis has identified targets for improving antimicrobial prescribing, focusing on choice, dosing and duration.

Sexually transmitted infections (STIs) place a substantial burden on outpatient health care and are a key focus for antimicrobial stewardship due to rising antimicrobial resistance. Suboptimal treatment can result in ongoing transmission, reinfection and complications, such as pelvic inflammatory disease. Evaluating prescribing quality is essential to improve patient care and support stewardship efforts. This review synthesises evidence on antimicrobial prescribing quality for STIs and identifies gaps to inform targeted interventions for this unique but critical setting. This PRISMA-ScR scoping review searched Ovid MEDLINE and Embase for English-language studies published from 2015 to May 2025 assessing antimicrobial prescribing quality for STIs in outpatient settings. Results were summarised descriptively; no formal critical appraisal was undertaken. Fifteen studies assessing antimicrobial prescribing quality for STIs in outpatient settings were included, predominantly from high-income countries, and focused on Neisseria gonorrhoeae and Chlamydia trachomatis. Substantial heterogeneity was observed in analytic units, denominators and outcome definitions, limiting comparability across studies. Prescribing quality was primarily assessed against national guidelines, although approaches varied from antimicrobial choice alone to multi-criteria and all-or-nothing assessments, with inconsistent terminology used throughout. Reported guideline concordance varied widely, with generally higher concordance for chlamydia than gonorrhoea. Antimicrobial prescribing for STIs in outpatient settings is both understudied and highly variable. Despite increasing global policy emphasis on antimicrobial stewardship, there are no standardised frameworks to support routine auditing in this setting. Developing standardised auditing approaches would improve surveillance, support stewardship efforts and identify opportunities to optimise prescribing practices across a broader range of STIs.

Abstract Background Microbiology testing can guide infectious disease management and antimicrobial selection, including for older people living in long-term care facilities (LTCFs), who are at high risk of infectious diseases. However, insufficient and excessive microbiology testing can contribute to inappropriate antimicrobial use. The study examined national trends, co-testing, and LTCF variation in microbiology testing. Methods This national repeated cross-sectional study included individuals aged 65–105 years residing in Australian LTCFs between 2009 and 2019. The annual age and sex standardised (i) proportion of individuals with a microbiology test and (ii) number of tests performed/100 resident-years were determined. Annual changes were estimated using adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) from Poisson or negative binomial models. Co-testing and LTCF variation in 2019 were also evaluated. Results Among the 547,067 studied residents, the median age at study entry was 84 years and 65.8% were women. Proportion of microbiology testing increased from 50.2% (95%CI 49.8–50.5) in 2009 to 59.4% (95%CI 59.0-59.7) in 2019 (aRR 1.02, 95%CI 1.01–1.02). Urine tests were the most frequently requested microbiology test, increasing from 40.9% (95%CI 40.5–41.2) to 44.9% (95%CI 44.5–45.2) during 2009–2019 (aRR 1.01, 95%CI 1.01–1.01). Nucleic acid amplification tests (NAATs) increased from 3.4% (95%CI 3.3–3.5) to 17.9% (95%CI 17.7–18.1) (aRR 1.21, 95%CI 1.21–1.21). In 2019, there were 1,614 (58.6%) LTCFs where the adjusted proportion of microbiology testing fell within the 95%CI range around the population mean. Faecal, Cryptosporidium/Giardia , and Clostridioides difficile/C.toxin tests were commonly performed concurrently with NAATs. Conclusions Over an 11-year period, microbiology testing increased. Eight out of ten residents were tested at least once during their LTCF stay, and considerable facility variation in testing was observed. Diagnostic stewardship targeting commonly requested microbiology tests (e.g., urine tests) could optimise antimicrobial use in LTCFs.

BACKGROUND:Antimicrobials are an adjunctive therapy in clinical dentistry. In dentoalveolar surgery, antimicrobials are not routinely required for surgical prophylaxis. This retrospective analysis of the Australian Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) dataset aimed to evaluate the guideline compliance and appropriateness of antimicrobial prescribing for dentoalveolar procedures in Australian hospitals. METHODOLOGY:Deidentified Surgical NAPS data for dentoalveolar procedures (tooth extractions and implant placements) between 2016 and 2022 were extracted. Procedures outside the scope of a general dentist were excluded. Prescribed antimicrobials for surgical prophylaxis, including procedural prophylaxis doses and post-procedural prescriptions, were assessed for guideline compliance and appropriateness according to the Surgical NAPS algorithm. RESULTS:1345 surgical episodes with dental procedures were included. This comprised 1077 procedural prophylaxis doses and 555 post-procedural prescriptions. Of the post-procedural prescriptions, 478 (86%) were for prophylaxis. Guideline compliance was demonstrated in 35.3% of procedural doses and 14.6% of post-procedural prescriptions. Rates of appropriateness were 33.5% for procedural doses and 12.6% for post-procedural prescriptions. Most procedural doses and post-procedural prescriptions were deemed inappropriate as they were not required (72.5% and 93.0%, respectively). CONCLUSIONS:Suboptimal guideline compliance and appropriateness of antibiotic prescribing for dentoalveolar surgery reinforces the need for antimicrobial stewardship interventions.

Objectives:Surveillance of antimicrobial prescribing quality is a core element of national antimicrobial resistance containment strategies. The National Antimicrobial Prescribing Survey (NAPS) programme was implemented in Bangladesh, Bhutan, and Nepal under the Fleming Fund-supported Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia project to strengthen national surveillance and stewardship capacity. The programme comprises setting-specific modules using standardized indicators including documentation quality, guideline concordance, and appropriateness. Methods:Between September 2024 and September 2025, Hospital NAPS point-prevalence audits were conducted in Bangladesh and Nepal, and Surgical NAPS was piloted in Bhutan. Audits were conducted in two phases to enable local interventions between rounds, incorporating stakeholder engagement, structured auditor training, and central quality assurance. Results:Ten hospitals completed audits encompassing 1299 patients (Hospital NAPS), 236 procedures (Surgical NAPS), and 2308 prescriptions. The programme produced baseline prescribing appropriateness data for the first time to inform stewardship priorities across district to tertiary settings. Key enablers included national engagement and establishment of antimicrobial stewardship committees; barriers included incomplete documentation, infrastructure limitations, and coordination challenges. Conclusion:The NAPS programme demonstrated feasibility across diverse health system contexts in three South-East Asia Region countries. Sustained leadership, routine practice integration, local ownership, and committed cross-institutional collaboration are critical for long-term stewardship impact.

Objectives This study examined the incidence of hospitalizations for urinary tract infections (UTIs) and associated factors among residents of long-term care facilities (LTCFs) during the first 12 months of their LTCF stay. Design Population-based retrospective cohort study. Setting and participants This study included people aged ≥65 years who first entered an LTCF between 2015 and 2018 using data from the Registry of Senior Australians National Historical Cohort. Methods The cumulative incidence of hospitalizations of UTI in the 12 months following LTCF entry was evaluated. Individual, facility, medicine, and service utilization-related factors associated with hospitalizations for UTIs were investigated. A Fine-Gray model was used to estimate subdistribution hazard ratios (sHRs) and 95% CIs. Results Of the 180,858 people included from 2464 LTCFs, 59.7% (n = 107,914) were female, with a median age of 85 years. The cumulative incidence of hospitalizations for UTIs in the 12 months after LTCF entry was 3.7% (95% CI 3.7-3.8). Factors associated with a higher rate of hospitalizations for UTIs included long-term urinary catheter use (sHR 3.39, 95% CI 3.16-3.65), history of hospitalizations with UTI (sHR 2.33, 95% CI 2.21-2.46), preferred language other than English (sHR 1.38, 95% CI 1.28-1.48), diabetes (sHR 1.29, 95% CI 1.22-1.37), high (sHR 1.30, 95% CI 1.19-1.41) or medium (sHR 1.21, 95% CI 1.11-1.32) need for assistance with activities of daily living, cerebrovascular disease (sHR 1.14, 95% CI 1.08-1.20), and urinary incontinence (sHR 1.08, 95% CI 1.01-1.15). Conclusions and implications A considerable burden of UTI-associated hospitalizations was observed in Australian LTCFs, which can be minimized through implementing effective UTI prevention, detection, and management strategies.

Background: Since 2013, the Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) has provided a standardized framework for hospitals to assess the quality of antimicrobial prescribing. As part of the program’s continuous quality improvement, a revised appropriateness algorithm was developed and is scheduled for implementation in 2025. This study aims to validate this algorithm by evaluating accuracy and inter-rater reliability (IRR) in assessing guideline concordance and appropriateness. Methods: A prototype of the revised assessment algorithm was developed using Qualtrics®, including an assessment of antimicrobial-level guideline concordance, appropriateness and reasons for non-optimal prescribing, as well as overall indication-level guideline concordance and appropriateness. An eLearning module was developed to ensure consistency of training for assessors. Fourteen clinical vignettes (ten general and four specialist) across a range of real-world clinical scenarios and with varying levels of complexity were developed. Gold standard assessments were determined by an independent group of infectious diseases (ID) and antimicrobial stewardship (AMS) clinicians. Existing Hospital NAPS users were invited to participate. General vignettes were split into two equal groups and assigned to assessors in an alternating manner. Those with expertise in haematology/oncology or paediatrics were assigned additional specialist vignettes. Results were analyzed for accuracy against the gold standard, and for IRR using Fleiss’ Kappa coefficient. Results: A total of 102 assessors, across a range of professions, remoteness areas and years of auditing experience, completed their assigned vignettes. Assessors correctly identified the antimicrobial regimen for auditing in 91.9% of assessments, with incorrectly identified assessments excluded. A total of 681 antimicrobial-level and 534 indication-level assessments were analyzed. Figure 1 summarizes the accuracy and IRR for the main outcome measures of guideline concordance and appropriateness. Accuracy and IRR were higher for appropriateness compared with guideline concordance, and at the overall indication-level compared with the antimicrobial-level. Auditors correctly identified all gold-standard reasons for non-optimal prescribing in 68.3% of assessments. Across all measures, accuracy and IRR was higher amongst assessors with specialist ID/AMS experience compared to those without, from metropolitan compared with regional settings, and amongst those with 4 or more years of auditing experience. Pharmacists without ID/AMS expertise scored as highly as doctors and pharmacists with ID/AMS expertise. Conclusion: The revised Hospital NAPS algorithm provides a valid measure of guideline concordance and appropriateness. Higher accuracy and IRR were observed for appropriateness compared with guideline concordance, highlighting the importance of appropriateness as a measure for stewardship surveillance in reflecting quality of patient care.

Introduction: Optimising antibiotic prescribing in hospitals through antimicrobial stewardship (AMS) initiatives is essential in addressing the global threat of antimicrobial resistance. Methods: Point prevalence surveys were performed in April 2019 and November 2022 utilizing the Hospital National Antimicrobial Prescribing Survey (NAPS) tool. The study aimed to evaluate the prevalence of antibiotic use among inpatients and monitor antibiotic prescribing quality in 2022 compared to 2019 in a Malaysian teaching hospital as part of AMS core elements. Results: The prevalence of antibiotic use remained relatively stable between 2019 and 2022 (44.1% vs. 42.3%), with no significant change observed. Prescription patterns, including the type of antimicrobials, treatment modalities, and prescriptions per patient, showed insignificant differences between the two surveys. Antibiotics from the World Health Organisation (WHO) Access group constituted up to 47% of prescriptions in 2022, while usage of antibiotics from Watch group decreased from 57% to 53%, albeit insignificantly. Notably, there was a non- significant increase in appropriate prescribing for surgical prophylaxis in 2022 (40% vs 16.7%, p=0.078), alongside a less prevalent in prolonged surgical prophylaxis (28% in 2022 vs. 50% in 2019). Despite static prevalence and prescribing patterns, compliance with guidelines (p<0.006) and appropriate prescribing (p<0.002) showed significant improvement. The likelihood of compliance and appropriate prescribing was approximately 1.8-fold higher in 2022 compared to 2019. However, an increase in prescription of unnecessary broad-spectrum antibiotics was observed (23.1% vs 48%, p=0.002). Multiple logistic regression revealed that inappropriate prescribing significantly occurred when antibiotic indication was poorly documented (adjusted OR 3.67;95% CI 1.28–10.53; p=0.016). Conclusion : While prescribing patterns remained relatively unchanged, our findings highlight notable improvement in antibiotic prescribing quality. However, challenges persist, including the increased use of unnecessary broad-spectrum antibiotics. Continued efforts in AMS are imperative to address these issues and further enhance prescribing practices.

Objective: To analyze antimicrobial prescribing practices in Australian emergency departments (ED), identifying prescribing areas requiring improvement. This aims to inform antimicrobial stewardship (AMS) strategies to enhance antimicrobial prescribing quality.Design Retrospective analysis of the Hospital National Antimicrobial Prescribing Survey (NAPS) data set.Setting EDs in public and private Australian hospitals (n = 652).Participants Hospitals (n = 652) that participated in the Hospital NAPS from 2013 to 2022.Methods Data were collected by trained auditors from participating hospitals with the use of a standardized auditing tool, the Hospital NAPS. Data from 2013 to 2022 were analyzed descriptively. Variables assessed included guideline compliance and appropriateness by antimicrobial and indication, and reasons for inappropriateness.Results There were 3,098 antimicrobial prescriptions from EDs included for analysis. Guideline compliance (63.5%) and appropriateness (70.4%) in EDs were lower compared to overall prescribing practices from all departments. The most commonly prescribed antimicrobial was ceftriaxone (16.9%, n = 523), and the most common indication was empiric prescribing for community-acquired pneumonia (16.0%, n = 497). Amoxicillin-clavulanic acid (53.2%, n = 99), and acute exacerbation of chronic obstructive pulmonary disease (54.3%, n = 57), were the antimicrobial and indication with the lowest rates of appropriateness respectively. Ceftriaxone prescribing also had a low rate of appropriateness (62.3%, n = 326). Selection of antimicrobials with too broad of a spectrum was the most common reason for inappropriateness (40.2%).Conclusion Antimicrobial prescribing quality in EDs warrants improvement. Recommended targets for AMS interventions are the excessive and inappropriate use of broad-spectrum antimicrobials such as ceftriaxone and amoxicillin-clavulanic acid in common respiratory and urinary tract infections.

Antimicrobial resistance (AMR) is a major public health threat with the highest burden being estimated to be in low- and middle-income countries. Fiji is an upper-middle-income country in Oceania. Recent studies from Fiji highlighted the increasing burden of carbapenem resistant organisms (CRO) such as Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli. A project titled Preparing Fiji for Pathogens with Critical Antimicrobial Resistance was undertaken at the Colonial War Memorial Hospital, Fiji’s main referral hospital, in 2022 and 2023. The overarching goal was to support the hospital’s readiness for prompt detection, management and prevention of infections caused by pathogens with critical AMR including CRO. This paper describes the steps taken to establish CRO surveillance, prevention, and control interventions, outbreak response and healthcare workers’ capacity building initiatives tailored to the hospital’s need and capacity. It also shares the results, lessons learned and challenges in setting up the systems that may inform actions in other low- and middle-income countries in the Pacific Region and globally.

Background: A comprehensive understanding of antimicrobial prescribing practices, requires antimicrobial stewardship (AMS) clinicians to assess both the quantity and quality of antimicrobial prescribing. In Australia, two national programs collect and analyse such data in the hospital setting; the National Antimicrobial Utilisation Surveillance Program (NAUSP) a continuous, volume-based surveillance program that monitors antimicrobial usage trends; and the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) a standardised auditing program that assesses antimicrobial prescribing appropriateness. This study aims to analyse the 2023 NAUSP and Hospital NAPS data to compare the volume and appropriateness of inpatient antimicrobial use in Australian hospitals. Methods: Data were extracted from hospitals that participated in both programs in 2023, including systemically administered antimicrobials for adult patients. NAUSP data were aggregated and acute inpatient usage rates relative to patient activity were calculated as Defined Daily Doses (DDD) per 1,000 Occupied Bed Days (OBD) for individual antimicrobials.

The global rise of antimicrobial resistance (AMR) poses a profound threat to human, animal and environmental health. Although antimicrobials have revolutionized modern medicine, their overuse and misuse have accelerated AMR, necessitating urgent, multisectoral action. Antimicrobial stewardship (AMS), a set of coordinated strategies that promote responsible antimicrobial use, has emerged as a key intervention in managing AMR. In this Review, we explore AMS within a One Health framework, emphasizing interconnectedness across sectors. We examine clinical, economic, sociocultural and environmental drivers of antimicrobial use, highlighting disparities between high-income and low-income settings and identifying context-specific challenges to implementation. We also discuss the importance of governance, financing, digital innovation, surveillance and behavioural science in shaping sustainable AMS programmes, and we consider core components, such as policy integration, surveillance of appropriateness, and context-aware interventions. This Review ultimately advocates for equity-focused strategies that better account for structural barriers, support marginalized populations, and ensure global access to high-quality antimicrobials. By aligning political will, funding and scientific innovation, AMS programmes can be scaled effectively to preserve antimicrobial efficacy, mitigate AMR, improve health outcomes, and promote global health security. The paper concludes with key recommendations for embedding AMS across sectors as a sustainable response to AMR. In this Review, James, Thursky and colleagues explore strategies that promote the responsible use of antimicrobials from a One Health perspective, emphasizing the roles of data and surveillance, implementation barriers, sociocultural and behavioural drivers, digital innovation and the need for greater inclusion of the agricultural and environmental sectors. They also highlight disparities between high-income and low-income settings and identify context-specific challenges to implementation.

Background:Inappropriate antimicrobial use is a key driver of antimicrobial resistance. Antimicrobial stewardship (AMS) promotes the judicious use of antimicrobials to address this problem. This study evaluated the effect of an AMS program on antimicrobial prescribing practices in district hospitals in Vietnam. Methods:A cluster randomised controlled trial was conducted in 16 district hospitals in northern and southern Vietnam over four months. Hospitals were randomly assigned to intervention or control groups. Interventions included establishing AMS committees and teams, distributing antimicrobial guidelines, training healthcare workers, providing patient educational material, and conducting periodic audits with feedback on antimicrobial prescribing. Co-primary outcomes were the "difference in differences" in (i) total antimicrobial consumption and (ii) inappropriate prescribing according to standardised guidelines, before and after the intervention, between intervention and control groups. Secondary outcomes included antimicrobial costs and all-cause mortality. After the intervention period, control sites also received the AMS program. Trial registry: Australia and New Zealand Clinical Trials Registry (ANZCTR) number 12622000715774. Findings:A total of 877 and 1220 antimicrobial prescriptions were reviewed in intervention hospitals, and 1277 and 1454 prescriptions in control hospitals at baseline and post-intervention. Inappropriate antimicrobial prescribing exceeded 60% in each hospital at baseline. After the intervention, inappropriate prescribing in the intervention group reduced by 6.3% (95% CI -10.9%, -1.7%) relative to the control group. Total antimicrobial consumption did not differ between groups, but antimicrobial costs reduced in the intervention group. No difference in all-cause mortality was observed. Interpretation:AMS interventions modestly reduced inappropriate antimicrobial prescribing in district hospitals in Vietnam, underscoring the importance of AMS in resource-limited settings. Funding:The Australian Department of Foreign Affairs and Trade.

Assessing the quality of antimicrobial prescribing is critical to combating antimicrobial resistance. The Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) assists in the assessment of antimicrobial prescribing appropriateness using consensus definitions, extending beyond guidelines compliance. Applying the Hospital NAPS in Portugal can address a knowledge gap. To assess the quality of antibiotic prescribing in a sample of Portuguese hospitals and evaluate Hospital NAPS implementability. A point prevalence audit using the translated and culturally validated Hospital NAPS definitions for Portugal and Hospital NAPS methodology was conducted across eight Portuguese hospitals from October 2023 to February 2024. Antimicrobial stewardship teams were surveyed to explore implementability. Among 2178 non-critical adult inpatients, 719 (33

Objectives:To evaluate the quality of systemic antifungal prescribing in Australian hospitals using point-prevalence survey data from the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS). Methods:Data were extracted from the Hospital NAPS dataset from January 2014 to December 2024. Systemic antifungal prescriptions were analyzed for antifungal use, guideline compliance, appropriateness, and reasons for inappropriateness according to the Hospital NAPS methodology. Demographic factors, hospital classifications, antifungals, and antifungal indication were compared. Results:A total of 7,830 systemic antifungal prescriptions from 372 healthcare facilities across all Australian states and territories were included. Overall 88.4% were guideline compliant and 92.3% of prescriptions were deemed appropriate. Fluconazole was the most commonly prescribed antifungal but had one of the lowest percentage appropriateness (88.4%). In contrast, mold-active azoles, echinocandins, and amphotericin B demonstrated appropriateness rates exceeding 90%. Prescriptions with approval through local antimicrobial stewardship (AMS) processes had significantly higher appropriateness than those without (95.9% vs. 82.9%, p < 0.001). Specialized facilities managing immunocompromised populations showed both higher antifungal use and higher prescribing quality compared to general acute public hospitals. Conclusion:This national evaluation highlights the overall high quality of systemic antifungal prescribing in Australian hospitals, reflecting the strength of AMS programs. However, variation across hospital types, specialties, and antifungal agents-particularly fluconazole-indicates opportunities for targeted stewardship interventions to further optimize antifungal use.

BACKGROUND:Excessive and improper use of antimicrobials is a major driver of antimicrobial resistance. Antimicrobial stewardship (AMS) addresses this by promoting judicious use of antimicrobials. This study evaluated the feasibility and effectiveness of an AMS program in district hospitals in Vietnam. METHODS:A before-and-after study was undertaken in four district hospitals in Vietnam over 6 months. Interventions included (i) establishing AMS committees and teams, (ii) distribution of antimicrobial guidelines, (iii) healthcare worker training, and (iv) conducting periodic standardised audits of appropriateness of antimicrobial prescriptions, followed by tailored feedback. The co-primary outcomes were (i) monthly antimicrobial consumption in the hospital and (ii) appropriateness of antimicrobial prescribing according to guidelines, before and after the AMS program. Secondary outcomes included changes in antimicrobial costs and all-cause mortality. RESULTS:The AMS program was successfully implemented with strong stakeholder engagement and high staff participation across all four hospitals. At baseline, 79.0 % (95 % CI: 74.9 %, 83.7 %) of 454 antimicrobial prescriptions were inappropriate, primarily due to prolonged duration, overly broad-spectrum agents, or incorrect dosing. No improvement was observed post-intervention, with 80.3 % (95 % CI: 77.4 %, 83.1 %) of 992 prescriptions deemed inappropriate. A modest reduction in antimicrobial consumption was seen post-intervention, with a decrease of 4.2 DDD/100 bed-days per month (95 % CI: - 6.2, - 2.3). Antimicrobial costs were unchanged. All-cause mortality reduced post-intervention [RR = 0.32 (95 % CI: 0.09, 0.92)]. CONCLUSION:AMS interventions were feasible to implement in district hospitals in Vietnam and resulted in modest reductions in antimicrobial consumption and all-cause mortality. However, the persistently high rates of inappropriate prescribing highlight the need for broader implementation and strengthening of stewardship efforts to more effectively address key drivers of antimicrobial resistance at the district level.

BACKGROUND:Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice. METHODS:A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013-2022) and surgical site infection data from Surgical NAPS (2016-2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness. RESULTS:From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, N=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, N=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, N=21,035 vs 67.4%, N=156,285; appropriateness 75.6%, N=30,639 vs 72.7%, N=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, N=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (N=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, N=350). CONCLUSIONS:As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.