Dataset Information

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey.

ABSTRACT:

Background

Electronic continuous surveillance databases are ideal for monitoring antibiotic use (ABU) in hospitalised patients for antibiotic stewardship programmes (ASP). However, such databases are scarce in low-resource settings. Point prevalence surveys (PPS) are viable alternatives. This report describes ABU and identifies ASP implementation improvement areas in Limpopo Province, South Africa.

Methods

This cross-sectional descriptive study extracted patient-level ABU data from patients' files using a modified global PPS tool. Data were collected between September and November 2021 at five regional hospitals in Limpopo Province, South Africa. All patients in the wards before 8 a.m. on study days with an antibiotic prescription were included. Antibiotic use was stratified by Anatomic Therapeutic Chemical and Access, Watch, Reserve classifications and presented as frequencies and proportions with 95% confidence intervals (CI). Associations between categorical variables were assessed using the chi-square test. Cramér's V was used to assess the strength of these associations.

Results

Of 804 inpatients surveyed, 261 (32.5%) (95% CI 29.2-35.7) were prescribed 416 antibiotics, 137 were female (52.5%) and 198 adults (75.9%). One hundred and twenty-two (46.7%) patients received one antibiotic, 47.5% (124/261) received two, and 5.7% (15/261) received three or more antibiotics. The intensive care units had a higher ABU (68.6%, 35/51) compared to medical (31.3%, 120/384) and surgical (28.5%, 105/369) wards (p = 0.005, Cramér's V = 0.2). Lower respiratory tract infection (27.4%, 104/379), skin and soft tissue infections (SST) (23.5%, 89/379), and obstetrics and gynaecology prophylaxis (14.0%, 53/379) were the common diagnoses for antibiotic prescriptions. The three most prescribed antibiotic classes were imidazoles (21.9%, 91/416), third-generation cephalosporins (20.7%, 86/416) and combination penicillin (18.5%, 79/416). Access antibiotics accounted for 70.2% (292/416) of prescriptions and Watch antibiotics for 29.6% (123/416) (p = 0.110, Cramér's V = 0.1). Reasons for prescribing and treatment plans were documented in 64.9% (270/416) (95% CI 60.3-69.5) and 21.4% (89/416) (95% CI 17.3-25.3) of prescriptions, respectively.

Conclusions

The study serves as a baseline for ABU surveillance at the five regional hospitals in Limpopo Province. Lack of documentation indicates poor prescribing practices; ASP should address gaps by deploying evidence-based, multifaceted and stepwise interventions.

SUBMITTER: Mthombeni TC

PROVIDER: S-EPMC10505321 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey.

Mthombeni Tiyani Comfort TC Burger Johanita Riétte JR Lubbe Martha Susanna MS Julyan Marlene M

Antimicrobial resistance and infection control 20230916 1

<h4>Background</h4>Electronic continuous surveillance databases are ideal for monitoring antibiotic use (ABU) in hospitalised patients for antibiotic stewardship programmes (ASP). However, such databases are scarce in low-resource settings. Point prevalence surveys (PPS) are viable alternatives. This report describes ABU and identifies ASP implementation improvement areas in Limpopo Province, South Africa.<h4>Methods</h4>This cross-sectional descriptive study extracted patient-level ABU data fro ...[more]

PMID: 37717012

Similar Datasets

Project description:ObjectiveEffective antimicrobial containment strategies such as Antimicrobial Stewardship Programs (ASPs) require comprehensive data on antibiotics use which are scarce in Ethiopia. This study sought to assess antibiotics use and healthcare-associated infections (HCAIs) in Ethiopian public hospitals.DesignWe conducted a cross-sectional study using the WHO point-prevalence survey protocol for systemic antibiotics use and HCAIs for low/middle-income countries.SettingThe study was conducted among 10 public hospitals in 2021.ParticipantsAll patients admitted to adult and paediatric inpatient and emergency wards before or at 08:00 on the survey date were enrolled.Outcome measureThe primary outcome measures were the prevalence of antibiotic use, HCAIs and the hospitals' readiness to implement ASP.ResultsData were collected from 1820 patient records. None of the surveyed hospitals had functional ASP. The common indication for antibiotics was for HCAIs (40.3%). Pneumonia was the most common bacterial infection (28.6%) followed by clinical sepsis (17.8%). Most treatments were empiric (96.7%) and the overall prevalence of antibiotic use was 63.8% with antibiotics prescription per patient ratio of 1.77. Ceftriaxone was the most commonly prescribed antibiotic (30.4%) followed by metronidazole (15.4%). Age, having HIV infection, ward type, type of hospital, catheterisation and intubation history had significant association with antibiotic use. Patients who were treated in paediatric surgical wards were about four times more likely to be on antibiotics compared with patients treated at an adult emergency ward. Patients on urinary catheter (adjusted OR (AOR)=2.74, 95% CI: 2.04 to 3.68) and intubation device (AOR=2.62, 95% CI: 1.02 to 6.76) were more likely to be on antibiotics than their non-intubated/non-catheterised counterparts. Patients treated at secondary-level hospitals had 0.34 times lower odds of being on antibiotics compared with those in tertiary hospitals.ConclusionsAntibiotic use across the surveyed hospitals was common and most were empiric which has both practical and policy implications for strengthening ASP and promoting rational antibiotics use.

Project description:ContextThe increase and global dissemination of antibiotic resistance limit the use of antibiotics to prevent and treat infections. Implementing antibiotic stewardship programs guided by local data on prescription profiles is a useful strategy to reduce the burden of antibiotic resistance. The aim was to determine the prevalence of antibiotic use and guideline compliance at Luang Prabang provincial hospital, Lao PDR.MethodsA point prevalence survey of antibiotics was conducted among hospitalized patients admitted to Luang Prabang hospital (204 beds) in Lao PDR on May 25, 2023. All patients presenting at 8:00 AM were eligible. Sociodemographic data, indications for antibiotic use, and antibiotic prescriptions were collected from medical records using a paper-based questionnaire and entered into an electronic platform following WHO methodology. The prevalence of antibiotic use was determined.ResultsOut of the 102 patients included, 60(58.8%) were undergoing antibiotic treatment, of which 33(55.0%) received combination therapy, and 7(10.5%) had two indications for antibiotic use. The highest prevalence was in the surgical ward (14/15, 93%) followed by general paediatrics (18/27, 67%). Out of the 100 antibiotic prescriptions, 47(47%) were for community-acquired infections, 26(26%) for surgical prophylaxis, 13(13%) for hospital-acquired infections and 5(5%) for medical prophylaxis. Twenty(20%) antibiotics were prescribed for obstetrics and gynaecology prophylaxis, 17(17%) for intra-abdominal infections, and 10(10.0%) for pneumonia treatment as well as bone, and joint infections. The main antibiotics prescribed were ceftriaxone 36(34.6%), metronidazole 18(17.3%), ampicillin 8(7.7%), and gentamicin 8(7.7%). Only 2(3%) samples were sent to the laboratory, one of which showed a positive culture for Escherichia coli Extended Spectrum β-Lactamase. According to the WHO Access Watch and Reserve classification, 55(52.9%) molecules belonged to the Access category, 47(49.1%) to the Watch category, and none to the Reserve category. Only 14.9% of antibiotic prescriptions were fully compliant with current guidelines.ConclusionThis study indicated a significant prevalence of antibiotic use and a very low compliance with guidelines at Luang Prabang provincial hospital, Lao PDR. This highlights an urgent need for comprehensive strategies at all levels to optimize antibiotic use in hospitals, emphasizing diagnostic improvements, and continued research to address the factors driving this excessive antibiotic usage and improve adherence to guidelines.

Project description:IntroductionTackling the inertia of growing threat of antimicrobial resistance (AMR) requires changes in how antibiotics are prescribed and utilized. The monitoring of antimicrobial prescribing in hospitals is a critical component in optimizing antibiotic use. Point prevalence surveys (PPSs) enable the surveillance of antibiotic prescribing at the patient level in small hospitals that lack the resources to establish antimicrobial stewardship programs (ASP). In this study, we analyzed antibiotic use at two public secondary care hospitals in Mexico using PPSs.MethodsFollowing WHO methodology, we conducted four cross-sectional PPSs on antibiotic use in two public secondary care facilities in Mexico: two surveys in a women's specialty hospital (H1) and two in a general referral hospital (H2). We collected data from clinical records of all patients with active antibiotic prescriptions (APs) across the medical, surgical, and mixed (MIX) wards, and intensive care units (ICUs). Descriptive statistics were computed to analyze the PPSs data using Stata.ResultsThe PPSs collected data on 127 patients, and 283 active APs. The prevalence of antibiotic use was 60.4% (H1, n = 29/48) and 70.5% (H2, n = 98/139). Antibiotics were more frequently used among patients in the MIX wards (H1: 87.5%, n = 14/16) and ICUs (H2: 90%, n = 9/10). The most frequent patient indications for antibiotic use were medical prophylaxis (H1: 51.7%, n = 15/29), community-acquired infections (H2: 42.9%, n = 42/98), and preoperative prophylaxis (H1: 27.6%, n = 8/29; H2: 23.5%, n = 23/98). The APs were mostly empirical (H1: 97%, n = 64/66; H2: 98.2%, n = 213/217), and parenterally administered (H1: 90.9%, n = 60/66; H2: 96.8%, n = 210/217). Most clinical records lacked documented post-prescription reviews (H1: 82.8%, n = 24/29; H2: 98%, n = 96/98). Preoperative prophylaxis was predominantly administered as multiple doses for more than one day. Penicillins with extended-spectrum (24.2%, n = 16/66), aminoglycosides (22.7%, n = 15/66), and first-generation cephalosporins (16.7%, n = 11/66) were the most prescribed antibiotic classes in H1, while third-generation cephalosporins (35%, n = 76/217), fluoroquinolones (14.3%, n = 31/217), and carbapenems (13.4%, n = 29/217) were the most prescribed in H2. No hospital had formally established ASP.ConclusionsThis study shows high prevalence rates of antibiotic use and variations in commonly prescribed antibiotic classes in public Mexican secondary care hospitals, along with shared practices in broad-spectrum antibiotic prescription. PPS-based surveillance enables the identification of specific targets to optimize antibiotic use according to the healthcare needs of patients in each hospital and facilitates comparative evaluations across hospitals.

Dataset Information

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey.

Background

Methods

Results

Conclusions

Publications

Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets