OBJECTIVES Antimicrobial Stewardship Programs commonly have an in-hospital focus. Little is known about the quality of antimicrobial use in hospital outpatient clinics. We investigated the extent and appropriateness of antimicrobial prescriptions in the outpatient clinics of three hospitals. METHODS From June 2018 to January 2019, we performed ten point prevalence surveys in outpatient clinics of one university hospital and two large teaching hospitals. All prophylactic and therapeutic prescriptions were retrieved from the electronic medical records. Appropriateness was defined as being in accordance with guidelines. Furthermore, we investigated the extent to which the dose was adjusted to renal function and documentation of an antibiotic plan in the case notes. RESULTS We retrieved 720 prescriptions for antimicrobial drugs, of which 173 prescriptions (24%) were prophylactic. A guideline was present for 95% of prescriptions, of which the guideline non-adherence rate was 25.6% (n = 42/164) for prophylaxis and 43.1% (n = 224/520) for therapy. Of all inappropriate prescriptions (n = 266), inappropriate prescriptions for skin and soft tissue infections (n = 60/226) and amoxicillin-clavulanic acid (n = 67/266) made up the largest proportion. In only 13 of 138 patients with impaired or unknown renal function the dosage regimen was adjusted. Amoxicillin-clavulanic acid was the drug for which most often renal function was not taken into account. In 94.6% of prescriptions the antibiotic plan was documented. CONCLUSIONS In hospital outpatient clinics, a substantial part of therapeutics were inappropriately prescribed. Amoxicillin-clavulanic acid was the most inappropriately prescribed drug, due to non-adherence to the guidelines and because dose adjustment to renal function was often not considered.

中文翻译：

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荷兰三家医院的门诊使用抗菌药物的适当性。

目标抗菌药物管理计划通常以医院内为重点。对于医院门诊中抗菌药物的使用质量知之甚少。我们调查了三家医院门诊诊所抗菌药物处方的范围和适当性。方法从2018年6月至2019年1月，我们在一家大学医院和两家大型教学医院的门诊进行了十点流行度调查。从电子病历中检索所有预防和治疗处方。适当性被定义为符合准则。此外，在病例记录中，我们调查了针对肾功能调整剂量的程度以及抗生素计划的文件。结果我们检索了720份抗菌药物处方，其中173个处方（占24％）具有预防作用。目前有95％的处方指南，其中预防的指南不依从率为25.6％（n = 42/164），治疗为43.1％（n = 224/520）。在所有不适当的处方中（n = 266），皮肤和软组织感染的不适当处方（n = 60/226）和阿莫西林-克拉维酸（n = 67/266）占最大比例。在138名肾功能受损或未知的患者中，只有13名患者调整了剂量方案。阿莫西林-克拉维酸是最不考虑肾功能的药物。在94.6％的处方中记录了抗生素计划。结论在医院的门诊诊所中，相当一部分治疗药物处方不当。