Background Qualitative work has described the differences in prescribing practice across medical and surgical specialties. This study aimed to understand if specialty impacts quantitative measures of prescribing practice. Methods We prospectively analysed the antibiotic prescribing across general medical and surgical teams for acutely admitted patients. Over a 12-month period (June 2016 - May 2017) 659 patients (362 medical, 297 surgical) were followed for the duration of their hospital stay. Antibiotic prescribing across these cohorts was assessed using Chi-squared or Wilcoxon rank-sum, depending on normality of data. The t-test was used to compare age and length of stay. A logistic regression model was used to predict escalation of antibiotic therapy. Results Surgical patients were younger (p < 0.001) with lower Charlson Comorbidity Index scores (p < 0.001). Antibiotics were prescribed for 45% (162/362) medical and 55% (164/297) surgical patients. Microbiological results were available for 26% (42/164) medical and 29% (48/162) surgical patients, of which 55% (23/42) and 48% (23/48) were positive respectively. There was no difference in the spectrum of antibiotics prescribed between surgery and medicine (p = 0.507). In surgery antibiotics were 1) prescribed more frequently (p = 0.001); 2) for longer (p = 0.016); 3) more likely to be escalated (p = 0.004); 4) less likely to be compliant with local policy (p < 0.001) than medicine. Conclusions Across both specialties, microbiology investigation results are not adequately used to diagnose infections and optimise their management. There is significant variation in antibiotic decision-making (including escalation patterns) between general surgical and medical teams. Antibiotic stewardship interventions targeting surgical specialties need to go beyond surgical prophylaxis. It is critical to focus on of review the patients initiated on therapeutic antibiotics in surgical specialties to ensure that escalation and continuation of therapy is justified.

中文翻译：

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普通医学和外科专业的抗生素处方：前瞻性队列研究。

背景技术定性工作描述了医学和外科专科医师在处方实践中的差异。这项研究旨在了解专业是否会影响处方实践的量化指标。方法我们前瞻性地分析了普通医疗队和外科手术队对急性入院患者的抗生素处方。在12个月的时间段（2016年6月至2017年5月）中，对659名患者（362名医疗人员，297名外科手术人员）进行了住院期间的随访。根据数据的正态性，使用卡方或Wilcoxon秩和评估了这些队列中的抗生素处方。t检验用于比较年龄和住院时间。使用逻辑回归模型预测抗生素治疗的升级。结果手术患者较年轻（p <0。001）的Charlson合并症指数得分较低（p <0.001）。对于45％（162/362）的医疗和55％（164/297）的外科手术患者，开出了抗生素处方。微生物结果可用于26％（42/164）的医疗患者和29％（48/162）的手术患者，其中55％（23/42）和48％（23/48）呈阳性。手术和药物治疗之间的抗菌谱没有差异（p = 0.507）。在外科手术中，抗生素1）的处方频率更高（p = 0.001）；2）更长（p = 0.016）；3）升级的可能性更大（p = 0.004）；4）与药物相比，符合当地政策的可能性较小（p <0.001）。结论在这两个专业中，微生物学调查结果均不足以用于诊断感染和优化感染管理。普通外科和医疗团队之间的抗生素决策（包括升级模式）差异很大。针对外科专业的抗生素管理干预措施不仅需要预防外科手术。至关重要的是，要集中精力审查在外科专业中开始使用治疗性抗生素的患者，以确保有理由进行升级和继续治疗。