The effectiveness of an antimicrobial stewardship program in an Australian rural hospital.

OBJECTIVE: The aim of this study was to investigate the type, indication and duration of restricted antibiotics prescribed to inpatients who had undergone antimicrobial stewardship (AMS) review by the infectious diseases specialist and to assess the effectiveness of the AMS program in a rural hospital. DESIGN: This was an observational retrospective study. SETTING: The study was conducted at a rural referral hospital in NSW. PARTICIPANTS: Inpatients from the medical, surgical and intensive care units were included. MAIN OUTCOME MEASURES: The main outcome measure was the type, indication and average duration of restricted antibiotics that were reviewed in the AMS rounds. The rate of adherence to AMS advice and the rate of step-down of antibiotics after AMS advice were other outcome measures. Data on participant characteristics were also collected. RESULTS: The most commonly prescribed restricted antibiotic in medicine and surgery was amoxicillin-clavulanic acid (28%), followed by ceftriaxone (15%) and piperacillin-tazobactam (10%), with the most common indication being intra-abdominal infection (37%). In intensive care, ceftriaxone (16.7%) and piperacillin-tazobactam (16.7%) were most prescribed, and the most common indication was community-acquired pneumonia (24.5%). The adherence rate to AMS advice was 86% in medicine and surgery and 83% in intensive care. AMS rounds managed to cease or step down antibiotics 60% of the time. CONCLUSION: The AMS program in a rural hospital was effective with an overall AMS advice adherence rate of 84.5% which measures well against tertiary-level centres. Continued AMS and advocacy of such programs in rural regions are fundamental to optimising patient outcomes in the rural community.

Postoperative complications, length of stay, and mortality following colectomies in rural hospitals: a systematic review and meta-analysis.

INTRODUCTION: Studies regarding patients who have underwent colectomy reported contradictory post-surgical complications based on their living areas. Due to the conflicting data surrounding whether rural or urban hospitals have lower postoperative complication rates, we have performed a systematic review and meta-analysis with the aim of understanding and assessing the evidence that has already been found. METHODS: The online databases PubMed, MEDLINE, EMBASE, SCOPUS, and CINAHL were searched for our literature review. We included papers with data on the postoperative complication rates for patients who had undergone colectomies. The patients were stratified based on the location status of the hospital, i.e. rural or urban. Data analysis was performed in Cochrane's Review Manager 5.41 software. RESULTS: A total of 921 studies were identified in the initial search; the inclusion and exclusion criteria refined the search results in 11 studies for review. The primary outcomes analyzed were mortality rate, length of stay and total complication rate. This review found that rural hospitals had either equal or lower inpatient postoperative mortality rates in comparison to urban hospitals for patients who had undergone colectomies. However, rural hospitals had a longer length of stay (mean length of stay in rural hospitals was 6.7 days and in urban hospitals was 4.9 days). It is important to note that the Australian hospitals had a mean length of stay of 13.5 days, which was almost double that of rural hospitals in America. The unadjusted rate of total complication was 26.51% in rural hospitals. CONCLUSIONS: Rural hospitals overall have equivalent postoperative complication rates to urban hospitals and can provide sufficient postoperative patient care.