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A Point Prevalence Survey of Antimicrobial Prescribing in a South Indian Tertiary Hospital; Using Global PPS Tool


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Identifying the targets for improving antimicrobial prescription and development of antimicrobial stewardship interventions can better serve to combat the situation of antimicrobial resistance. The primary objective was to determine the prevalence of antimicrobial use at tertiary care teaching hospital with both acute and long-term care patients. A periodical point prevalence survey was done in a tertiary care hospital of South India during 2019 using manual and web-based GLOBAL-PPS tool. Of 945 patients eligible for the study, 645 (69.5 %) received at least one antibiotic, with highest rates in the adult surgical ward and pediatrics. Of 645 therapeutic antibiotic prescriptions, 58.6% prescriptions have an infectious indication of them, 62.6% are community-acquired infections. Third-generation cephalosporins were the most prescribed antibiotics. The prevalence of antibiotic use is very high, and our study evidence that the country needs a robust antimicrobial stewardship intervention program.
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*Author for correspondence
Asian Journal of Pharmaceutical Research and Health Care, Vol 13(1), 1-9, 2021
ISSN (Online) : 2250-1460
DOI: 10.18311/ajprhc/2021/26368
Identifying the targets for improving antimicrobial prescription and development of antimicrobial stewardship
interventions can better serve to combat the situation of antimicrobial resistance. The primary objective was to determine
the prevalence of antimicrobial use at tertiary care teaching hospital with both acute and long-term care patients. A
periodical point prevalence survey was done in a tertiary care hospital of South India during 2019 using manual and web-
based GLOBAL-PPS tool. Of 945 patients eligible for the study, 645 (69.5 %) received at least one antibiotic, with highest
rates in the adult surgical ward and pediatrics. Of 645 therapeutic antibiotic prescriptions, 58.6% prescriptions have an
infectious indication of them, 62.6% are community-acquired infections. Third-generation cephalosporins were the most
prescribed antibiotics. The prevalence of antibiotic use is very high, and our study evidence that the country needs a robust
antimicrobial stewardship intervention program.
A Point Prevalence Survey of Antimicrobial
Prescribing in a South Indian Tertiary
Hospital; Using Global PPS Tool
Vineela Chadalavada1, Manohar Babu S.2 and Balamurugan K.1*
1Department of Pharmacy, Annamalai University, Annamalai Nagar, Chidambaram - 608002,
Tamil Nadu, India;,
2Deparment of Pharmacy, Sims College of Pharmacy, Mangaldas Nagar, Guntur - 522001, India
1. Introduction
Antimicrobial drugs have revolutionized the treatment
of infectious diseases, becoming the cornerstone of
therapy for infectious diseases to reduce morbidity and
mortality1. However, there is increasing Antimicrobial
Resistance (AMR) as a result of their overuse, which has
become a serious problem worldwide2. India is the world’s
largest consumer of antibiotics for human health, which
was reported 12.9 x 109 units (10.7 units per person)
in 20103. e Indian Government has issued a National
Policy for Containment of Antimicrobial Resistance
(AMR) to promote surveillance on antimicrobial use in
the community and hospitals settings across the country.
Data about the quantity and quality of antimicrobial
prescribing constitute the cornerstone for guiding
Keywords: Antimicrobial Prescribing, Antimicrobial Resistance, Antimicrobial Stewardship, GLOBAL-PPS, India
antimicrobial stewardship (ASP’s) interventions4. India
has implemented certain measures to control irrational
antimicrobial use; “red strip labelling of antimicrobial
packages” which indicates the drug should not be
dispensed without a legal prescription5.
Antimicrobial consumption data of 65 countries
presented in the WHO report for 2015-18, found wide
discrepancies in consumption rates between countries.
However, no countries from south-east Asia, including
India, have submitted their report while eorts are
initiated and ongoing in such countries with the national
surveillance programs. Initial reports from India stated
a very high level of consumption of third-generation
cephalosporins in all its states. e WHO reported India
as one of the countries for high irrational antimicrobial
A Point Prevalence Survey of Antimicrobial Prescribing in a South Indian Tertiary Hospital; Using Global PPS Tool
Asian Journal of Pharmaceutical Research and Health Care
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use and inadequate surveillance and high rates of drug
Point Prevalence Survey (PPS) in a structured
qualitative assessment of Antimicrobial consumption at a
given point of time. It is a feasible method to access data
on antimicrobial use and helps to target improvement
in the quality of antimicrobial prescribing and establish
interventions for better ASH. Periodical PPS serve better
ASH and assist in the ght against AMR7. PPS is a based
stewardship tool in a few developed countries, but in other
countries across the globe, clinicians have just begun to
understand and explore how to use it7 - 8. In India, very few
Point prevalent surveys of antibiotic use were reported,
and most of them are registered in pediatrics7 - 12. To our
knowledge; our present study is probably the rst from
Andhra Pradesh state of South India. e data gives an
insight into the pattern of antimicrobial use and help in
2. Materials and Methods
2.1 Study Settings and Design
Global PPS method was adopted for the present point
prevalence survey on antibiotic use at a tertiary care
hospital. Point prevalence study (PPS) carried out
periodically during January, May, August and December
2019 in a tertiary care hospital from Andhra Pradesh
state of South India. It is a private multispecialty hospital
(300 beds) located in the of Vijayawada, Andhra Pradesh
province in South India. e present PPS study was
designed and conducted using a structured web-based
Global-PPS tool. e study tools were prepared based on
point prevalence survey methodology on antibiotic use in
hospitals from WHO- version 1.1 as a reference tool13, 14.
e Institutional ethical committee at Andhra
Hospitals initially approved the study proposal. e study
is a non-experimental surveillance study with minimal
risk; however, written informed consent was obtained
from the patient or legal guardian under International
Conference on Harmonization-Good Clinical Practice
(ICH GCP) guidelines.
2.2 Inclusion and Exclusion Criteria
In the hospital, all the in-patients admitted at 8 am
receiving at least one antimicrobial, for at least one
clinical condition, prophylaxis on the day of the survey
was included for the study. A patient receiving an
antibiotic, e.g., every 48 hours but not receiving this
antibiotic on the survey day was considered ongoing
antimicrobial treatment. New-born healthy children on
a maternity ward receiving antibiotics were encoded as
a Neonatal Medical Ward (NMW) and included in the
study. Surgical ward was surveyed on the day following
the day when most elective surgical interventions usually
take place or have been planned. Data was not collected
from the out patients, patients discharged before 8 oclock
and admitted with intervention aer that study time are
excluded from the study.
2.3 Sample Size
e estimated sample size necessary for the study was
obtained using sample size calculator as 377, where ‘p’
was assumed to be 50%, allowable error ‘e’ was 5% and ‘z’
being the standard normal deviate with a value of 1.9615.
To conduct any drug utilization studies, a sample size of
at least 100 subjects was suggested by the world health
organization (WHO)16. However in our study, a sample
size of 645 was evaluated to obtain the outcomes.
2.4 Data Collection
Data of antibiotic use patterns were collected from the
hospital on a single day following the ESAC and Global-
PPS audit tool guidelines, also known as PPS tool17.
A well-structured data collection forms and
denitions of various variables are available at Global-
PPS website; ward data collection form and patient
data collection form were primarily used for the survey
Antimicrobials were classied using the World Health
Organization’s (WHO) Anatomic erapeutic Chemical
(ATC) classication16. e ATC groups included as
antimicrobial are J01 (Antibacterial for systemic use),
J02 (Antimitotics), J04A (Anti-tubercular drugs),
A07AA (Antibiotics for intestinal infections), D01BA
(Antifungals), J05 (Antiviral’s), P01AB (Antiprotozoals)
and P01B (antimalarials).
Additional quality indicators included; the
documented indication before the initiation of treatment;
the compliance of prescription to the standard guidelines
on antibiotic selection; if a stop or review information
entered in the notes; prophylaxis, empiric or targeted
treatment (based on microbiological data); the use of a
biomarker of infection (e.g., C reactive protein) to inform
antibiotic treatment was noted. Further information
Vineela Chadalavada, Manohar Babu S. and Balamurugan K
Asian Journal of Pharmaceutical Research and Health Care 3
Vol 13 (1) | 2021 |
on the denitions used in the Global-PPS protocol is
available online17.
In the rst three months, the data from data collection
forms were veried before entering into a validation
form. Analysis of data was performed using SPSS version
16.0 soware. In the month of December, our hospital got
registered in Global-PPS web-based application system,
where the present participating hospital data is being
freely entered. e Global –PPS website team performed
statistical analysis for the month of December and
generated a report on complete antimicrobial use at our
hospital during the respective period. e data from this
report was pooled and utilized for further analysis.
3. Results
Out of 945 patients admitted with various indications
in the hospital during survey days, 645 (69.5%) received
at least one antibiotic on the day of PPS. e highest
antimicrobial use was evident in the adult surgical ward
(78.8%) pediatric (61.1%) and neonatal medical wards
(64%) (Table 1).
Of 645 therapeutic antibiotic prescriptions, 378
(58.6%) prescriptions have an infectious indication of
them, 237 (62.6%) are community-acquired infections,
and 37.3% are hospital-acquired infections while 267
(41.4%) prescriptions were issued for medical (28.4%),
surgical (67.4%) prophylaxis and 4.1% targeted therapy.
Among the top ten diagnoses for which antibiotics
were prescribed gastrointestinal infections (26.9%)
and bacteremia (23.5%) account for the highest rate.
According to the ATC classication system, antibacterial
for systemic use (J01) accounted for 82.3% (Table 2).
Table 1. Overall antimicrobial prevalence
Total (N) Treated patients
No. of hospitalised
patients 945 645 (69.5)
Antimicrobial prevalence in the medical wards
AMW = Adult
Medical Wards 455 330 (72.5)
Pneumology AMW 40 40 (100)
ASW = Adult Surgical
Ward 180 142 (78.8)
AICU = Adult
Intensive Care Unit 130 40 (30.7)
PMW = Pediatric
Medical Ward 90 55 (61.1)
NICU = Neonatal
Intensive Care Unit 50 50 (100)
* Patients (N) = number of admitted adults.
Treated patients (%) = 100*(number of adults treated with at
least one antimicrobial/number of admitted adults).
Table 2. General characteristics and antibiotic
prescription patterns of patients surveyed
Indications for antimicrobial prescription
N=645 No. Of patients Percentage (%)
(n=378) (58.6%)
acquired infection
237 62.6
141 37.3
(n=267) (41.4%)
180 67.4
76 28.4
Targeted therapy 11 4.1
Top Infection for which antibiotics are prescribed n=378
Bacteremia 89 23.5
102 26.9
Infection of central
nervous system
18 4.7
31 8.2
Pyrexia of
unknown origin
52 13.7
36 9.5
Fever neutropaenic
16 4.2
Pneumonia 21 5.5
Other 13 3.4
Parenteral therapy 531 82.3
Multiple ATB
237 36.8
A Point Prevalence Survey of Antimicrobial Prescribing in a South Indian Tertiary Hospital; Using Global PPS Tool
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ird-generation cephalosporins (26.2%) were the
most commonly prescribed antibiotic groups, followed by
penicillins (13.5%), quinolones (9.8%). (Table 3, Figure
1). e distribution of various classes of antibiotics in
medical, surgical, ICU and pediatric units, was depicted
in (Figure 2). Among the dierent antimicrobial agents
prescribed for systemic use (J01 ATC), the overall
most frequently prescribed antibiotics were ceriaxone
(28.4%), meropenem (7.8%), Amikacin (7%) and
pipercillin with a beta-lactamase inhibitor (6.5%) and
levooxacin (11.7%); these ve antibiotics accounted
for 396 (61.4%) prescriptions (Table 4) (Figure 3).
Antimicrobial quality indicators presented in the hospital
Multiple ATB
364 56.4
* Multiple ATB diagnosis is dened as receiving > 1 antibiotic
(J01) for a single identied reason to treat (=diagnose code) at
patient level.
Multiple ATB patients are dened as receiving > 1 antibiotic
(J01) at patient level.
Table 3. Overall proportion of antimicrobial agents prescribed
Total (%) N=645 Medical (%) Surgical (%) ICU/ (%) Paediatric /
NICU (%)
Tetracyclines (J01AA) 4 3.1 0 0.9 0
Penicillins 13.5 6.6 0 2.4 4.5
J01C 6.3 3.8 0 0.9 1.6
J01CR 6.5 2.1 0 1.5 2.9
Other beta−lactams 42.2
J01DB 0 0 0 0 0
J01DC 1.8 1.8 0 0 0
J01DD 26.2 15.2 3.2 4.4 3.4
J01DF 0.9 0.9 0 0 0
J01DH 8.2 3.2 0 3.2 1.8
J01FA 5.1 2.1 1.3 1.1 0.6
J01GB 72.4 0 1.3 3.3
J01MA 9.8 5.4 2 0.3 2.1
P01CA 5.2 3 0 1.8 0.4
Others 5.5 2.3 0.2 0 1.2
Tetracyclines (J01AA), Penicillins with extended spectrum (J01CA), Combinations of penicillins, incl. beta−lactamase inhibitors
(J01CR), Second−generation cephalosporins (J01DC), ird−generation cephalosporins (J01DD), Fourth−generation cephalosporins
(J01DF), Carbapenems (J01DH), Macrolides (J01FA), Lincosamides (J01FF), Aminoglycosides (J01GB), Quinolones (J01MA),
Nitroimidazole Derivatives (P01CA)
are shown in the (Table 5). e reason for antimicrobial
use recorded for 89% medical, 100% surgical and 74.4%
ICU prescriptions. e stop/review date was entered for
only 26 % medical and 12% surgical prescriptions. While,
43% medical, 44% surgical, 26% of ICU prescriptions
are found in compliance with the hospital antimicrobial
guidelines (Table 5).
4. Discussion
e present study is probably the rst study describing
antimicrobial use in Andhra Pradesh state in India
using a point prevalence survey (Global-PPS). A PPS
served as an inexpensive, convenient antimicrobial
consumption surveillance system. e number of patients
increased over time, as did the proportion treated with
an antimicrobial18. Such a trend is a challenge to the
hospitals surveyed and indicates that growing eorts are
needed from hospital sta. ere is no debate that the rate
of antimicrobial prescribing in India is high compared to
Vineela Chadalavada, Manohar Babu S. and Balamurugan K
Asian Journal of Pharmaceutical Research and Health Care 5
Vol 13 (1) | 2021 |
Figure 1. Portion of antibiotic use in the study settings.
Tetracyclines (J01AA), Penicillins with extended spectrum
(J01CA), Combinations of penicillins, incl. beta−lactamase
inhibitors (J01CR), Second−generation cephalosporins
(J01DC), ird−generation cephalosporins (J01DD),
Fourth−generation cephalosporins (J01DF), Carbapenems
(J01DH), Macrolides (J01FA), Lincosamides (J01FF),
Aminoglycosides (J01GB), Quinolones (J01MA), Nitroi
midazole Derivatives (P01CA)
Figure 2. Antimicrobials prescribed by classication.
Figure 3. Top 5 most frequently used prescribed antibiotics
in adults and children.
many other countries, which is a concern that requires
addressing urgently.
We report a higher rate of antimicrobial use (62.6%)
similar to few studies from India 51.6% & 61.5% &
64.74%7, 9 - 10. PPS studies from various countries reported
antimicrobial use; French (32.2%), Sweden (33.3%), turkey
(30.6%), Jordan (46.2%), Belgian (27.1%), Brazil (52.2%),
Nigeria (69.7%), Switzerland (33%) Canada (65%), Egypt
(59%), Saudi (46.9%) and China (56%)19 - 30. However, this
overall prevalence masks important regional dierences:
2017 data showed that among 68 hospitals in East and
South Asia the prevalence of antimicrobial use was 48.2%,
compared with 29.6% in 106 European hospitals. ere
have been few previous studies in India. However, our
data are comparable to a study in Eastern India, which
reported antimicrobial use prevalence of 62% in 2014 and
69.1% in 20178. From (gure 2), the highest prevalence
of antibiotic use in the present study was in surgical and
pediatrics while it was in Gynecology ward reported in a
similar study done at south India7.
In our study, a signicant portion of antibiotics was
mostly used for the treatment of community-acquired
infections (62.6%), and these results are similar to studies
in Nigeria and Sweden and to two other studies conducted
in India, which reports community acquired infections
(CAI) as an indication with the highest prevalence of
antimicrobial use7, 12. e clinical sign documented for
the treatment with antimicrobials is vital to evaluate
compliance with national antimicrobial treatment guide
lines (ICMR Guidelines).
On reviewing empirical antimicrobial therapies with
CAI, the two most common antimicrobials were third
generation cephalosporins (26.2%) (Table 3) which is
similar to two other Indian studies7, 11. e similar wide use
of cephalosporins was reported in Turkey, Jordan, Brazil,
Nigeria and Saudi. However, in European countries,
wide use of Fluoroquinolones in French and Belgian,
Amoxicillin/Clavulanic acid combination in Northern
Ireland and Switzerland were reported18 - 29. Guidelines
recommend the use of third-generation Cephalosporins
only when rst-line agents are ineective31. Hence this
study identied an opportunity to improve antimicrobial
use by prescribing rst-line drugs for hospitalized CAI
Some poor-prescribing practices such as indications
for the therapy and low documentation rate of stop or
review dates to guide the scheduled antimicrobial therapy
may result in healthcare sta administering medication
A Point Prevalence Survey of Antimicrobial Prescribing in a South Indian Tertiary Hospital; Using Global PPS Tool
Asian Journal of Pharmaceutical Research and Health Care
6Vol 13 (1) | 2021 |
5. Conclusion
is study indicated a high rate of antibiotic prescription
with increased usage of third-generation Cephalosporins.
ese ndings suggest critical areas for interventions and
propose implementation of antimicrobial stewardship
policies in the present study hospital. e current survey
was in a singles institute, and we further suggest such
periodical surveys in multiple institutions across the state
for the development of strong antibiotic policies. Our
study evidence the country needs strong antimicrobial
stewardship intervention program.
6. Conicts of Interests
No reported conicts to declare.
7. Funding
No nancial support was received by any of the authors
for conducting this survey.
for the inappropriate duration (Table 5). e condition
might be due to lack of quality-assured procedures and
guidelines32. Surprisingly, the majority of prescriptions
comply with the hospital prescribing guidelines. In
the present study settings, an antimicrobial policy was
structured and made practiced at the hospital by a clinical
pharmacist is much appreciable. Besides, a very high rate
of parenteral use of antimicrobials was reported, contrary
to the advocated practices in antimicrobial stewardship
program. ere was no utilization of biomarkers across
the study hospital because they are novel and expensive.
However, they are a viable adjunct to guide therapy in
select patients such as those in whom sepsis is suspected.
Some limitations should be acknowledged. As this was
a point prevalence survey, patients were not followed-up
in time. is study only shows a snapshot of the situation
and shallow sample size; therefore, they are not ideal
for measuring, for example, Antimicrobial use (AMR).
Good outcomes with antimicrobials (i.e., appropriate
antimicrobial prescribing and reduction of resistance
to antimicrobials) require the use of antimicrobial
stewardship approaches and completion of PPS at regular
Table 4. Top 5 most frequently used prescribed antibiotics in adults and children
Antibiotic Medical (%)
Surgical (%)
ICU/ (%)
atric / NICU (%)
Levooxacin 5.7 0 3.4 2.6 11.7%
Meropenem 12.5 0 1.6 0 7.8 %
Amoxicillin and Clavulanic acid 3.2 0 0 3.3 6.5
xone 16.3 3.6 8.5 0 28.4%
Amikacin 5.6 0 0 1.4 7%
Table 5. Quality indicators of antibiotic prescribing
Indicator Medical (%) Surgical (%) ICU (%)
Indication for treatment was recorded Yes 89 100 74.4
Compliance with the hospital guidelines
Compliant 43 44 26
Not compliant 20 26 19
Not-assessable 21 18 13
No information 16 12 42
Stop/review date documented Yes 26 64 0
Targeted therapy Yes 11 0 0
Biomarkers Yes 0 0 0
Vineela Chadalavada, Manohar Babu S. and Balamurugan K
Asian Journal of Pharmaceutical Research and Health Care 7
Vol 13 (1) | 2021 |
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Knowledge and perception of rational Antimicrobial Use (AU) help in developing interventions to improve AU. Data to target AU surveillance and interventions are provided by Point Prevalence surveys, which are a resource-effective alternative to prospective surveillance. Point Prevalence Survey (PPS) on AU provides a snapshot of antibiotic use at a given point of time and can be repeated at regular intervals to monitor trends. It provides data that can be fed back to front line clinicians and used to inform discussions about stewardship. In Our 670 bedded tertiary care Hospital, we did the PPS during last week of Jan 2019 in the identified wards and ICU's. A survey team reviewed patients' case sheet and noted antibiotics prescriptions on the date of the survey. Other important details such as admitting ward, age, sex, total number of patients on admissions, administered antibiotics and its route, their dosages, dosing intervals, patients' clinical diagnosis and indications for antibiotic use, Hospital-acquired infections (HAI) or Community-acquired (CAI) and surgical antibiotic prophylaxis (SAP) or Medical antibiotics prophylaxis(MAP). Of 502 patients admitted in the hospital, 325(64.7%) received ≥1 Antimicrobial orders (AO) on the date of the survey. Of 325 total AOs, 98 (30.2 %) were administered for (SAP) surgical prophylaxis, 19(5.84%) for Medical prophylaxis, (MAP), 23(7%) for reasons not documented in the medical record, i.e., Unknown-(UK), 167 (51.38%) were for CAI and 18(5.3%) for HAI. Parenteral Cefotaxim was the most prevalent antibiotic generally used and for all types of infection onset category.51% of all prescriptions for CAI was for respiratory infections. Broad spectrum AO treatment was prevalent, for both SAP and CAI infections. Understanding common reasons for Antibiotic use (e.g., Lower respiratory infection) can help focus education and stewardship efforts on areas in which improved use may have the greatest impact.
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The aim of the study was to assess antimicrobial prescribing patterns, and variation in practice, in India. A point prevalence survey (PPS) was conducted in October to December 2017 in 16 tertiary care hospitals across India. The survey included all inpatients receiving an antimicrobial on the day of PPS and collected data were analysed using a web-based application of the University of Antwerp. In all, 1750 patients were surveyed, of whom 1005 were receiving a total of 1578 antimicrobials. Among the antimicrobials prescribed, 26.87% were for community-acquired infections; 19.20% for hospital-acquired infections; 17.24% for medical prophylaxis; 28.70% for surgical prophylaxis; and 7.99% for other or undetermined reasons. Antibiotic prescribing quality indicators, such as reason in notes and post-prescription review score, were low. This PPS showed widespread antibiotic usage, underlining the need for antibiotic stewardship to promote evidence-based practice.
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Background: To assess antimicrobial prescribing in a Northern Ireland hospital (Antrim Area Hospital (AAH)) and compare them with those of a hospital in Jordan (Specialty Hospital). Methods: Using the Global-PPS approach, the present study surveyed patients admitted to the hospital in 2015, the prescribed antibiotics, and a set of quality control indicators related to antibiotics. Results: Ultimately, 444 and 112 inpatients in the AAH and the Specialty Hospital, respectively, were surveyed. For the medical group, 165 inpatients were prescribed 239 antibiotics in the AAH, while 44 patients in the Specialty Hospital were prescribed 65 antibiotics. In relation to the surgical group, 34 inpatients treated for infection were prescribed 66 antibiotics in the AAH, while 41 patients in the Specialty Hospital treated for infection were prescribed 56 antibiotics. For the medical patients, the most frequently prescribed antibiotics in the AAH were a combination of penicillins (18.8%) and penicillins with extended spectrum (18.8%). For the surgical patients, the most frequently prescribed antibiotics in the AAH were imidazole derivatives (24.2%). For the medical and surgical patients in the Specialty Hospital, the most frequently prescribed antibiotics were third-generation cephalosporins (26.2 and 37.5%, respectively). In medical patients, compliance to guidelines was 92.2% in the Specialty Hospital compared to 72.0% in the AAH (p < 0.001). In surgical patients, compliance to guidelines was 92.7% in the Specialty Hospital compared to 81.8% in the AAH (p = 0.012). Conclusions: The present study highlighted differences in the utilisation of antimicrobials between two hospitals in two distinct regions and benchmarked antibiotic prescriptions across two hospitals.
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Objective: To evaluate the antibiotic prescribing trends, qualitatively and quantitatively, among Saudi Ministry of Health (MOH) hospitals. Method and materials: In May 2016, information about the hospitals and patients was collected for all inpatients from 26 MOH hospitals in Saudi Arabia. Additional information about antibiotic treatment and infections was gathered. Data collection was done using Global Point Prevalence Survey (PPS) tool designed by University of Antwerp, Belgium. Results: A total of 3240 antibiotic doses were administrated to 2182 patients who represented 46.9% of the total eligible admitted patients. Of those patients on antibiotics, 510 (24%) patients were in the Intensive Care Unit (ICU), 646 (30.4%) patients were medically treated, and 972 (45.7%) patients were in surgical departments. The most commonly prescribed antibiotic group was third-generation cephalosporin (17.2%) and the most frequent indication was respiratory ract infectiont (n=597; 18.2%). Antibiotics for surgical prophylaxis represented 23.4% of the total antibiotic doses. Of those, 78% were administrated for more than 24hs. The rate of adherence to antibiotic guidelines was 48.1%. The indications for antibiotics were not documented in the patients' notes for 51.1% of the prescriptions. Conclusion: This national PPS provided a useful tool to identify targets for quality improvement in order to enhance the prudent use of antibiotics in hospital settings. This survey can provide a background to assess the quality of antibiotic utilisation after any intervention by administering it regularly.
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Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux.
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Background: Information about antimicrobial use is scarce and poorly understood among neonatal intensive care units (NICUs) in India. In this study, we describe antimicrobial use in eight NICUs using four point prevalence surveys (PPSs). Methods: As part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) study, one-day, cross-sectional, hospital-based PPSs were conducted four times between 1 February 2016 and 28 February 2017 in eight NICUs. Using a standardized web-based electronic data entry form, detailed data were collected for babies on antimicrobials. Results: A total of 403 babies were admitted to NICUs across all survey days, and 208 (51.6%) were prescribed one or more antimicrobials. Among 208 babies, 155 (74.5%) were prescribed antimicrobials for treatment of an active infection. Among 155 babies with an active infection, treatment was empiric in 109 (70.3%). Sepsis (108, 49.1%) was the most common reason for prescribing antimicrobials. Amikacin (17%) followed by meropenem (12%) were the two most commonly prescribed antimicrobials. For community-acquired sepsis, piperacillin-tazobactam (17.5%) was the most commonly prescribed drug. A combination of ampicillin and gentamicin was prescribed in only two babies (5%). Conclusions: The recommended first-line antimicrobial agents, ampicillin and gentamicin, were rarely prescribed in Indian NICUs for community acquired neonatal sepsis.
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Quantitative and qualitative analysis were used to ascertain practices, perceptions and barriers about antibiotic stewardship program (ASP) in an oncology hospital in eastern India. In 2014 and 2017, 62% and 69.1% of the patients audited were found to be on anti infective medications respectively. Nearly 47% of patients in the study group (2014) who were on therapeutic antibiotics had an average cost of $46.48 per patient per day (inter-quartile range: $17.23-$94.76). Antibiotic related consultations from clinical microbiologists, was found to be in demand, and education of prescribers and policymakers was identified as critical to the success of ASP. © 2017 Indian Journal of Medical Microbiology Published by Wolters Kluwer -Medknow.
Background: The inappropriate use of antimicrobials and increased rates of antimicrobial resistance is a challenge all over the world. Although antibiotic stewardship is recommended by the Brazilian government, data regarding antibiotic use in Brazilian hospitals are scarce. Aim: The aim of this study was to conduct a point prevalence survey of antimicrobial use in 18 Brazilian hospitals. Methods: Eighteen Brazilian hospitals conducted the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) in 2017. The study enrolled inpatients on antimicrobials. Data collection included details on the antimicrobial prescriptions. A web-based program was used for data-entry, validation and reporting. The Global-PPS was developed by the University of Antwerp and bioMérieux provided funding support. Findings: We evaluated 1801 patients, of which 941 (52.2%) were on antimicrobials. Four hundred (42.5%) patients were given at least two antimicrobials. Out of the 1317 antibacterials for systemic use, 514 (39%) were prescribed for community-acquired infections, 533 (40.5%) for healthcare-associated infections and 248 (18.8%) for prophylactic use. The most frequently used antimicrobials were ceftriaxone (12.8%), meropenem (12.3%) and vancomycin (10.3%). Pneumonia or lower tract respiratory infection was the the most common site of infection (29.2%). In general, antimicrobials were given mainly parenterally (91%) and empirically (81.2%). Conclusions: We observed a high prevalence of antibiotic use in the 18 Brazilian hospitals. The antibiotics were prescribed mainly empirically. Intravenous broad-spectrum antibiotics were the most frequent antimicrobials used, showing that reinforcement of de-escalation strategy is needed. The Global-PPS data can be very useful for monitoring stewardship programmes and intervention.
BackgroundA point prevalence survey (PPS) on healthcare-associated infections (HAI) and antimicrobial use was conducted in Swiss acute care hospitals in 2017.AimOur objective was to assess antimicrobial use in Swiss acute care hospitals.Methods All patients hospitalised in any acute care hospital in Switzerland were eligible. We used the most recent version of the PPS protocol of the European Centre for Disease Prevention and Control.ResultsData from 12,931 patients of 96 hospitals were collected. Of these, 4,265 (33%; 95% confidence interval (CI): 32.2-33.8) were on 5,354 antimicrobials for 4,487 indications. Most of the 2,808 therapeutic indications addressed 1,886 community-acquired infections (67.2%; 95% CI: 65.4-68.9). Of the 1,176 surgical prophylaxes, 350 (29.8%; 95% CI: 27.1-32.4) exceeded the duration of 1 day. Of the 1,090 antimicrobial regimens that were changed, 309 (28.3%; 95% CI: 25.7-31.0) were escalated and 337 (30.9%; 95% CI: 28.2-33.7) were de-escalated. Amoxicillin/clavulanic acid was the most frequent antimicrobial (18.8%; 95% CI: 17.7-19.8), prescribed mainly for therapeutic indications (76.0%; 95% CI: 73.3-78.7). A total of 1,931 (37.4%; 95% CI: 36.1-38.8) of the 5,158 antimicrobials for systemic use were broad-spectrum antibiotics, most frequently third- and fourth-generation cephalosporins (35.9%; 95% CI: 33.8-38.1).Conclusions Antimicrobial consumption was at European average, the use of broad-spectrum antibiotics in the lower third. Swiss acute care hospitals should invest in antimicrobial stewardship, particularly in reducing the use of broad-spectrum antibiotics.