Decade-long national study finds antimicrobial use in Australian hospitals improves with regular monitoring

by Peter Doherty Institute for Infection and Immunity

edited by Lisa Lock, reviewed by Robert Egan

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A 10-year national study has found improved antimicrobial use in Australian hospitals that regularly monitored their prescribing, using a globally unique program developed by a Melbourne hospital. The study reinforces the importance of antimicrobial stewardship to improve patient care and minimize antimicrobial resistance.

Launched in 2013, the National Antimicrobial Prescribing Survey (NAPS) program was developed and is coordinated by the Royal Melbourne Hospital's (RMH) Guidance Group and the National Centre for Antimicrobial Stewardship (NCAS) at the Peter Doherty Institute for Infection and Immunity (Doherty Institute) to monitor and assess the appropriateness of antimicrobial prescribing practices. It also contributes to the Antimicrobial Use and Resistance in Australia (AURA) surveillance program.

Director-General of the Australian CDC, Professor Zoe Wainer, emphasized the critical nature of the program. "Antimicrobial resistance is a significant threat to human health, and robust data is essential to track and respond to it at a national level."

After analyzing 10 years of data from 543 Australian hospitals, researchers at the RMH, Doherty Institute and the University of Queensland confirmed the program improved antimicrobial use for hospitals that participated year after year. However, opportunities remain to improve prescribing in rural hospitals and for some common antimicrobials.

Recently published in the international journal Clinical Microbiology and Infection, the findings could have implications for standards across more than 13 participating countries.

Lead author Caroline Chen, a senior antimicrobial stewardship (AMS) pharmacist at the RMH and NCAS, said the results validated more than a decade of work. "Across the board, we found that 74% of antimicrobials were prescribed appropriately and hospitals that regularly monitored their antimicrobial prescribing were more likely to prescribe them better over time," Chen said.

"However, the appropriateness of prescribing in regional and remote hospitals was behind that of their major-city counterparts, and it's important these hospitals receive the support and resources they need for antimicrobial stewardship.

"We also found that the broader-spectrum antimicrobials, which are closely monitored or restricted by hospitals, were prescribed more appropriately than narrow-spectrum antimicrobials, which are traditionally considered low risk and are typically unrestricted."

According to the World Health Organization, antimicrobial resistance is one of the top global public health and development threats. Chen, an early leader in AMS in Victoria and part of the team that developed the program, explained that antimicrobial prescribing is complex.

"Antimicrobial prescribing is not easy—the need to prevent and treat infections impacts almost every facet of modern medicine, and so it is vital we ensure antimicrobials are used appropriately for the best patient care and to preserve their effectiveness into the future. While auditing requires time and resources from AMS clinicians, this study demonstrates that it is effective," Chen said.

Infectious disease physician Dr. Irani Thevarajan leads the RMH's participation in NAPS and said it is a powerful tool to improve antimicrobial prescription quality and, therefore, patient outcomes at the hospital.

"Inappropriate antimicrobial prescribing has major impacts on patient care, including prolonged hospital admission, treatment failures or increased risks of antimicrobial resistance," Thevarajan said.

"With the NAPS program, we can systematically assess antimicrobial prescribing and use these insights to continuously improve prescribing, ensuring our patients receive the most appropriate medication and care."

Associate Professor Brendan McMullan from the School of Clinical Medicine at UNSW and participant in NAPS, said that antibiotics are such an important part of health care today that it's almost impossible to imagine a world without them.

"NAPS is a fantastic Australian-led initiative that allows us to understand how well we're using these medicines across the lifespan, from newborns to people in aged care. That information is crucial to improving how we use antimicrobials and so keep people healthy now and into the future," McMullan said.

The RMH's Professor Karin Thursky, director of NCAS, said the team conceived the NAPS program from feedback, international literature and their own experiences as RMH clinicians wanting the best and safest care for their patients.

"At its center is the structured and unified method of assessing appropriateness of antimicrobial prescribing. It is globally unique and to this day there are no other international antimicrobial surveillance programs that do this," said Thursky.

"We are proud that the NAPS program continues to deliver positive patient outcomes, not just here at the RMH, but also nationally and internationally."

Wainer concluded, "I congratulate NCAS on the completion of this study. It clearly demonstrates the important role the NAPS program plays in providing valuable data and insights into antimicrobial use, as part of the AURA surveillance program."

More information

Caroline Chen et al, Impact of repeated auditing in antimicrobial stewardship programs on prescribing appropriateness: a ten-year observational cohort study of a national surveillance program, Clinical Microbiology and Infection (2026). DOI: 10.1016/j.cmi.2026.05.028

Key medical concepts

Antimicrobial ResistanceAntimicrobial Stewardship

Clinical categories

Infectious diseasesPreventive medicine Provided by Peter Doherty Institute for Infection and Immunity Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Robert Egan

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