Multidrug resistant gram-negative bacteria in Tasmania: An audit based pilot study

Objectives: Multidrug resistant gram-negative (MRGN) bacteria are increasing in prevalence globally. Accurate prevalence data contributes to limiting the proliferation of these organisms. The aim of this research was to identify the prevalence of MRGN bacteria within an Australian health district and to establish the risk factors associated with their acquisition through the development and piloting of a novel audit tool.

Methods: An audit based pilot study was conducted using a specifically developed tool that collected pathology and patient data on all patients with new MRGN bacteria notifications during 2013 in one Australian health district.

Results: There were 68 new MRGN bacteria notifications in the health district in 2013; 42 of these had sufficient data for auditing. The majority of bacteria identified were Escherichia coli (n = 43, 63.2%) and the majority of specimens were urine (n = 47, 69.1%). Urine specimens were more prevalent in females compared to males (72% vs 28%, χ2 13.98, p < 0.001). Sixty-five percent of patients were aged 65 and over (n = 44), and 25% were aged 85 and over (n = 17). More than half of the patients with full data available (n = 22) were administered antibiotics during admission, predominantly broad-spectrum varieties.

Conclusions: This pilot study identified several areas of concern, including poor documentation practices, and management of patients with dementia, particularly those with urinary catheters. Discrepancies between antibiotic prescribing practices and Therapeutic Guidelines were identified and an audit of antibiotic prescribing and reasons for deviation could improve practice and reduce the burden of multidrug resistance. Enhanced screening of MRGN bacteria should be considered to provide data for management and tracking of resistance, and could be enhanced through use of the audit tool.