Point prevalence survey of antibiotic use in hospitals in Latin American countries.
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ABSTRACT: Background
Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals.Methods
An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection.Results
Between December 2018 and August 2019, 5444 patients in 33 hospitals in five countries were included (10 hospitals in Cuba, 7 in Paraguay, 6 in El Salvador, 5 in Mexico and 5 in Peru). Of these patients, 54.6% received at least one antibiotic, with variations between and within hospitals and countries. Antibiotics were more frequently used in ICUs (67.2%), SUR (64.5%) and MED wards (54.2%), with 51.2% of antibiotics prescribed for community-acquired infections (CAIs), 22.9% for healthcare-associated infections (HAIs), 11.1% for surgical prophylaxis and 6.1% for unknown reasons. Adherence to guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs and 44.3% for prophylaxis). Third-generation cephalosporins were the class of antibiotics most frequently used (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases.Conclusions
Antibiotic use was generally higher than that published in other studies. There is an urgent need to promote and strengthen the antimicrobial stewardship programmes in Latin America.
SUBMITTER: Levy Hara G
PROVIDER: S-EPMC9092443 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
Publications
Point prevalence survey of antibiotic use in hospitals in Latin American countries.
Levy Hara Gabriel G Rojas-Cortés Robin R Molina León Helvert Felipe HF Dreser Mansilla Anahí A Alfonso Orta Ismary I Rizo-Amezquita José Noe JN Santos Herrera René Guillermo RG Mendoza de Ayala Silvia S Arce Villalobos Marlen M Mantilla Ponte Hilda H Davila Ever E Aguilar Gloria G Porrás Analía A Ramón-Pardo Pilar P Castro José Luis JL
The Journal of antimicrobial chemotherapy 20220201 3
<h4>Background</h4>Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals.<h4>Methods</h4>An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection.<h4>Results</h4>Betwee ...[more]
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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.
| S-EPMC11698459 | biostudies-literature
Project description:Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization's standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.
| S-EPMC8868487 | biostudies-literature
Project description:Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.
| S-EPMC9202938 | biostudies-literature
Project description:ObjectivesTo describe the antibiotic use among hospitalized patients in Thailand.MethodsA standardized cross-sectional point prevalence survey (PPS) modified from the WHO PPS protocol was conducted in 41 selected hospitals in Thailand. All inpatients who received an antibiotic at 9 a.m. on the survey date were enrolled. The total number of inpatients on that day was the denominator.ResultsBetween March and May 2021, a total of 8958 inpatients were enumerated; 4745 inpatients received antibiotics on the day of the survey and there were 6619 prescriptions of antibiotics. The prevalence of antibiotic use was 53.0% (95% CI 51.1%-54.0%), ranging from 14.3% to 73.4%. The antibiotic use was highest among adults aged >65 years (57.1%; 95% CI 55.3%-58.9%). From 6619 antibiotics prescribed, 68.6% were used to treat infection, 26.7% for prophylaxis and 4.7% for other or unknown indications. Overall, the top three commonly used antibiotics were third-generation cephalosporins (1993; 30.1%), followed by first-generation cephalosporins (737; 11.1%) and carbapenems (703; 10.6%). The most frequently used antibiotics for community-acquired infections were third-generation cephalosporins (36.8%), followed by β-lactam/β-lactamase inhibitors (11.8%) and carbapenems (11.3%) whereas for the patients with hospital-acquired infections, the most common antibiotics used were carbapenems (32.7%), followed by β-lactam/β-lactamase inhibitors (15.7%), third-generation cephalosporins (11.7%) and colistin (11.7%). The first-generation cephalosporins were the most commonly used antibiotics (37.7%) for surgical prophylaxis. Seventy percent of the patients received surgical prophylaxis for more than 1 day post surgery.ConclusionsThe prevalence of antibiotic use among hospitalized patients in Thailand is high and one-quarter of these antibiotics were used for prophylaxis. The majority of surgical prophylaxis was inappropriately used for a long duration post operation. Therefore, it is recommended that local guidelines should be developed and implemented.
| S-EPMC9825250 | biostudies-literature
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.
| S-EPMC8845215 | biostudies-literature
Project description:BackgroundActionable data on antimicrobial use is important when planning strategic interventions such as antimicrobial stewardship to address the challenge of drug resistance, particularly in resource-constrained settings.ObjectivesTo assess the prevalence of antibiotic use, the pattern of commonly used antibiotics and patient factors that may be associated with the increased use of antibiotics in the study hospitals.MethodsThis was a cross-sectional study conducted using the WHO Methodology for Point Prevalence Surveys in hospitals. Chi-squared analysis, Fisher's exact test and logistic regression were employed to analyse statistically the data obtained.ResultsThe overall prevalence of antibiotic use in the hospitals was 60.5%. The commonest indications for antibiotic recommendations were community-acquired infections (36.5%), surgical prophylaxis (26.1%) and hospital-acquired infections (15.7%), among others. Very few (2.7%) of the patients had their samples taken for culture and susceptibility testing to guide therapy. Penicillins (48.7%), cephalosporins (23.5%) and fluoroquinolones (17.4%) were the most commonly prescribed antibiotics. Concurrent malaria infection [adjusted OR (AOR) 0.33, 95% CI 0.11-0.94, P = 0.04] and increasing age (AOR 0.98, 95% CI 0.96-1.00, P = 0.02) were associated with lower risk of antibiotic use.ConclusionsThe prevalence of antibiotic consumption in the hospitals was lower than that reported in similar studies in Ghana, but high relative to some reports from high-income countries. Most antibiotic therapy was empirical and not guided by culture and susceptibility testing. There is the need for application of the WHO AWaRe classification for the selection of antibiotics and increased use of culture and susceptibility data to guide infectious disease therapy.
| S-EPMC8210176 | biostudies-literature
Project description:BackgroundImproper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana.MethodsBetween October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units.ResultsOf 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples.ConclusionWe found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.
| S-EPMC6588883 | biostudies-literature
Project description:ObjectiveAntimicrobial resistance (AMR) renders many bacterial infections untreatable and results in substantial morbidity and mortality worldwide. Understanding antibiotic use in clinical settings including hospitals is critical to optimize antibiotic use and prevent resistance.DesignHospital antibiotic point prevalence survey (PPS).MethodsThe study was conducted in two large, teaching hospitals in Addis Ababa, Ethiopia. We performed two survey rounds in December 2021 and January 2022 through real-time chart review using the World Health Organization PPS methodology. Data were collected using a web-based database, and descriptive statistics were performed to analyze antibiotic use by various characteristics.ResultsAmong 1020 hospitalized patients, 318 (32%) were ≤14 years and 370 (36%) had surgery during the current hospitalization. A total of 662 (65%) were receiving an antibiotic on the day of survey and 346 (39%) were receiving ≥2 antibiotics. A community-acquired infection (43%) was the most common indication for an antibiotic followed by surgical prophylaxis (27%) and hospital-acquired infection (23%). Antibiotic use was highest among those ≤24 months in age and among patients in trauma, surgical, and pediatric wards. Cephalosporin (42%) and penicillin (16%) antibiotics were the most frequently prescribed classes. Only 11% of patients on antibiotics had samples collected for microbiological testing; hence, almost all antibiotic therapy was empiric.ConclusionsDespite global and national efforts to improve antimicrobial stewardship, antibiotic use remains high in urban teaching hospitals in Ethiopia. Implementation of antimicrobial stewardship activities and microbiology utilization are needed to guide antimicrobial selection and curtail antibiotic overuse.
| S-EPMC11500273 | biostudies-literature
Project description:BackgroundThe objective of this study was to identify antibiotic stewardship (AS) opportunities in Latin American medical-surgical intensive care units (MS-ICUs) and general wards (Gral-wards).MethodsWe conducted serial cross-sectional point prevalence surveys in MS-ICUs and Gral-wards in 41 Latin American hospitals between March 2022 and February 2023. Patients >18 years of age in the units of interest were evaluated for antimicrobial use (AU) monthly (MS-ICUs) or quarterly (Gral-wards). Antimicrobial data were collected using a standardized form by the local AS teams and submitted to the coordinating team for analysis.ResultsWe evaluated AU in 5780 MS-ICU and 7726 Gral-ward patients. The hospitals' median bed size (interquartile range) was 179 (125-330), and 52% were nonprofit. The aggregate AU prevalence was 53.5% in MS-ICUs and 25.5% in Gral-wards. Most (88%) antimicrobials were prescribed to treat infections, 7% for surgical prophylaxis and 5% for medical prophylaxis. Health care-associated infections led to 63% of MS-ICU and 38% of Gral-ward AU. Carbapenems, piperacillin-tazobactam, intravenous (IV) vancomycin, and ampicillin-sulbactam represented 50% of all AU to treat infections. A minority of IV vancomycin targeted therapy was associated with documented methicillin-resistant Staphylococcus aureus infection or therapeutic drug monitoring. In both units, 17% of antibiotics prescribed as targeted therapy represented de-escalation, while 24% and 15% in MS-ICUs and Gral-wards, respectively, represented an escalation of therapy. In Gral-wards, 32% of antibiotics were used without a microbiologic culture ordered. Half of surgical prophylaxis antibiotics were prescribed after the first 24 hours.ConclusionsBased on this cohort, areas to improve AU in Latin American hospitals include antibiotic selection, de-escalation, duration of therapy, and dosing strategies.
| S-EPMC11530953 | biostudies-literature
Project description:ObjectiveTo delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes.DesignCross-sectional analytical study.SettingSix referral hospitals in Tanzania.ParticipantsPatients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected.Outcome measuresWe analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO's AWaRe categorisation of antibiotics.ResultsApproximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin-cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results.ConclusionsEmpirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.
| S-EPMC7745526 | biostudies-literature