Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Background

As evidence is mounting regarding irrational and often unnecessary use of antibiotics during the COVID-19 pandemic a cross-sectional Point Prevalence Survey (PPS) (in accordance with WHO guideline) was conducted across COVID-19 dedicated wards in Dhaka Medical College and Hospital (DMCH).

Methodology

Antibiotic usage data were collected from 193 patients at different COVID-19 dedicated wards at DMCH on 11 June 2020. Comparisons in antibiotic usage were made between different groups using Pearson chi-square and Fisher's exact test.

Result

Findings reveal all surveyed patients (100%) were receiving at least one antibiotic with 133 patients (68.91%) receiving multiple antibiotics. Overall, patients presenting with the severe disease received more antibiotics. Third-generation cephalosporins (i.e. ceftriaxone) (53.8%), meropenem (40.9%), moxifloxacin (29.5%), and doxycycline (25.4%) were the four most prescribed antibiotics among surveyed patients. Diabetes mellitus (DM) was independently associated with multiple antibiotic prescribing. Abnormal C-reactive protein (CRP) and serum d-dimer were linked with higher odds of multiple antibiotic prescribing among study patients.

Conclusion

Prevalence of multiple antibiotic prescriptions was high among severely ill patients and those with abnormal CRP and d-dimer levels. Data regarding the quality of antibiotic prescribing were lacking.

A point prevalence survey to assess antibiotic prescribing in patients hospitalized with confirmed and suspected coronavirus disease 2019 (COVID-19)

Background

Earlier studies have reported high antibiotic use in patients hospitalised for coronavirus disease 2019 (COVID-19), resulting in concerns of increasing antimicrobial resistance with increase antibiotic use in this pandemic. Point prevalence survey (PPS) can be a quick tool to provide antibiotic prescribing information to aid antimicrobial stewardship (AMS) activities.

Objectives

To describe antibiotic utilization and evaluate antibiotic appropriateness in COVID-19 patients using PPS.

Methods

Adapting Global-PPS on antimicrobial use, the survey was conducted in COVID-19 wards at 2 centres in Singapore on 22 April 2020 at 0800h. Patients on systemic antibiotics were included and evaluated for antibiotic appropriateness.

Results

Five hundred and seventy-seven patients were screened. Thirty-six (6.2%) patients were on antibiotics and which were started at median of 7 days (inter-quartile rate (IQR), 4, 11) from symptom onset. Fifty-one antibiotics were prescribed in these patients. Overall, co-amoxiclav (26/51, 51.0%) was the most often prescribed antibiotic. Thirty-one out of 51 (60.8%) antibiotic prescriptions were appropriate. Among 20 inappropriate prescriptions, 18 (90.0%) were initiated in patients with low likelihood of bacterial infections. Antibiotic prescriptions were more appropriate when reviewed by infectious diseases physicians (13/31 [41.9%] versus 2/20 [10.0%], p = 0.015), and if reasons for use were stated in notes (31/31 [100.0%] versus 16/20 [80.0%], p = 0.019).

Conclusions

Despite low prevalence of antibiotic use among confirmed and suspected COVID-19 patients at 2 centres in Singapore, there was significant proportion of inappropriate antibiotics use where bacterial infections were unlikely. AMS teams can tailor stewardship strategies using PPS results.

Identifying opportunities for antimicrobial stewardship through a point prevalence survey in an Indian tertiary-care teaching hospital

OBJECTIVES

Unregulated and inappropriate use of antimicrobial agents has been a major driver of antimicrobial resistance with a dangerous impact on health issues in developing nations. We report an audit of antimicrobial use patterns in a tertiary-care teaching hospital in order to identify opportunities for antimicrobial stewardship.

METHODS

A point prevalence survey was conducted to study the use of ten selected antibiotics in various adult inpatient facilities. Patient characteristics as well as indications and patterns of antibiotic prescription were recorded.

RESULTS

A total of 188 patients received any one of the survey antibiotics, accounting for 43% of patients admitted under the study specialties. Of the 188 patients, 59% were admitted in non-intensive care unit settings. The median (interquartile range) duration of hospitalisation during the survey was 8 (4.75) days. Intra-abdominal infections (75; 40%) and respiratory infections (41; 22%) were the most common reasons for admission. Empirical antibiotic use was observed in 66% of patients. Antimicrobial use without any microbiological test was evidenced in 32 patients (17%). Significant differences were noted between medical and surgical specialties in choice of antibiotic, dosage and utilisation of microbiological tests.

CONCLUSIONS

High empirical antibiotic use, poor transition from empirical to rational use, and underutilisation of microbiological tests were noted. The choice of antibiotics differed among specialties. Inappropriate dosing was greater in surgical specialties, especially with aminoglycosides. Adherence to local antibiotic policy, optimal dosing and audit of reserved antibiotic use can be useful approaches to strengthen antimicrobial stewardship programmes.

Electronically assisted surveillance systems of healthcare-associated infections: a systematic review

Background

Surveillance of healthcare-associated infections (HAI) is the basis of each infection control programme and, in case of acute care hospitals, should ideally include all hospital wards, medical specialties as well as all types of HAI. Traditional surveillance is labour intensive and electronically assisted surveillance systems (EASS) hold the promise to increase efficiency.

Objectives

To give insight in the performance characteristics of different approaches to EASS and the quality of the studies designed to evaluate them.

Methods

In this systematic review, online databases were searched and studies that compared an EASS with a traditional surveillance method were included. Two different indicators were extracted from each study, one regarding the quality of design (including reporting efficiency) and one based on the performance (e.g. specificity and sensitivity) of the EASS presented.

Results

A total of 78 studies were included. The majority of EASS (n = 72) consisted of an algorithm-based selection step followed by confirmatory assessment. The algorithms used different sets of variables. Only a minority (n = 7) of EASS were hospital-wide and designed to detect all types of HAI. Sensitivity of EASS was generally high (> 0.8), but specificity varied (0.37–1). Less than 20% (n = 14) of the studies presented data on the efficiency gains achieved.

Conclusions

Electronically assisted surveillance of HAI has yet to reach a mature stage and to be used routinely in healthcare settings. We recommend that future studies on the development and implementation of EASS of HAI focus on thorough validation, reproducibility, standardised datasets and detailed information on efficiency.

Point prevalence survey of antimicrobial use in three hospitals in North-Eastern Tanzania

Background

Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania.

Methods

A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 h and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day.

Results

A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n = 94, 29.8%), metronidazole (n = 79, 23.9%) and other antibiotics belonging to the penicillin class (n = 89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases.

Conclusion

Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.

Antibiotic use in Kenyan public hospitals: Prevalence, appropriateness and link to guideline availability

•

We report findings from a point prevalence survey across 14 Kenyan public hospitals.

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About half of the hospitalised patients received appropriate antibiotic therapy.

•

Laboratory investigations supported less than 1% of the antibiotic prescriptions.

•

Physical availability of treatment guidelines influenced treatment appropriateness.

•

There is need for context-specific, up-to-date, and accessible treatment guidelines.

Objective

To examine prescription patterns and explore to what extent guidelines are available and how they might influence treatment appropriateness among hospitalised patients in Kenyan hospitals.

Methods

Data on antimicrobial usage were collected from hospitalised patients across 14 Kenyan public hospitals. For each prescription, appropriateness of treatment was defined using available local and international treatment guidelines and through consensus with local medical specialists. Association between appropriate treatment, guideline availability and other possible explanatory factors was explored using univariate and multiple regression analysis.

Results

There were 1675 (46.7%) of the 3590 hospitalised patients on antimicrobials with 3145(94%) of the 3363 antimicrobial prescriptions being antibiotics. Two patients (0.1%), had treatment based on available antibiotic susceptibility tests. Appropriate treatment was assessed in 1502 patients who had a single diagnosis. Of these, 805 (53.6%) received appropriate treatment. Physical availability of treatment guidelines increased the odds of receiving appropriate treatment Odds Ratio 6.44[95% CI 4.81–8.64].

Conclusion

Appropriate antibiotic prescription remains a challenge in Kenyan public hospitals. This may be improved by the availability of context-specific, up-to-date, and readily accessible treatment guidelines across all the departments, and by providing better diagnostic support.

Point prevalence surveys of antimicrobial use: a systematic review and the implications

Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.

A 2-year point-prevalence surveillance of healthcare-associated infections and antimicrobial use in Ferrara University Hospital, Italy

Background

Healthcare-Associated Infections (HAIs) represent one of the leading issues to patient safety as well as a significant economic burden. Similarly, Antimicrobial Use (AMU) and Resistance (AMR) represent a growing threat to global public health and the sustainability of healthcare services.

Methods

A Point Prevalence Survey (PPS) following the 2016 ECDC protocol for HAI prevalence and AMU was conducted at Ferrara University Hospital (FUH). Data were collected by a team of trained independent surveyors in 2016 and 2018. Risk factors independently associated with HAI were assessed by a multivariate logistic regression model.

Results

Of the 1102 patients surveyed, 115 (10.4%) had an active HAI and 487 (44.2%) were on at least 1 systemic antimicrobial agent. Factors independently associated with increased HAI risk were a “Rapidly Fatal” McCabe score (expected fatal outcome within 1 year), presence of medical devices (PVC, CVC, indwelling urinary catheter or mechanically assisted ventilation) and a length of hospital stay of at least 1 week. The most frequent types of HAI were pneumonia, bloodstream infections, and urinary tract infections. Antimicrobial resistance to third-generation cephalosporins was observed in about 60% of Enterobacteriaceae.

Conclusions

The survey reports a high prevalence of HAI and AMU in FUH. Repeated PPSs are useful to control HAIs and AMU in large acute-care hospitals, highlighting the main problematic factors and allowing planning for improvement actions.

Point prevalence survey of antimicrobial use and healthcare-associated infections in Belgian acute care hospitals: results of the Global-PPS and ECDC-PPS 2017

Background

The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017.

Methods

Belgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September-December 2017. All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS.

Results

Overall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5-27.6%) was found. The most frequently reported indications were pneumonia (23.2%), urinary tract infections (15.2%) and skin and soft tissue infections (11.9%). The reason for antimicrobial use was recorded for 81.9% of the prescriptions, a stop/review date for 40.8% and compliance with local antibiotic guidelines for 76.6%. In the ECDC-PPS, the crude prevalence of patients with at least one HAI was 7.3% (95%CI 6.8-7.7%). Most frequently reported HAIs were pneumonia (21.6%) and urinary tract infections (21.3%).

Conclusions

HAI and antimicrobial use prevalence remained stable in comparison with the previous PPS (7.1% and 27.4% in 2011 and 2015, respectively). Belgian hospitals should be further stimulated to set local targets to improve antibiotic prescribing and reduce HAI.

Global point prevalence survey of antimicrobial consumption in Brazilian hospitals

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. 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 programme was used for data-entry, validation and reporting. The Global-PPS was developed by the University of Antwerp and bioMérieux provided funding support.

FINDINGS

A total of 1801 patients were evaluated, 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 respiratory tract infection was the most common site of infection (29.2%). In general, antimicrobials were given mainly parenterally (91%) and empirically (81.2%).

CONCLUSIONS

A high prevalence of antibiotic use was observed 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.

Linezolid use in German acute care hospitals: results from two consecutive national point prevalence surveys

Background

Linezolid belongs to a reserve group of antibiotics. In recent years, reports on linezolid resistance in gram-positive cocci have become more frequent. Overuse of linezolid is a relevant factor for resistance development. The objective of this study was to describe current prescription practices of linezolid in German hospitals and identify targets for antimicrobial stewardship interventions.

Methods

We analyzed all linezolid prescriptions from the datasets of the consecutive national point prevalence surveys performed in German hospitals in 2011 and 2016. In both surveys, data on healthcare-associated infections and antimicrobial use were collected following the methodology of the European Centre for Disease Prevention and Control.

Results

Overall, the percentage of linezolid among all documented antimicrobials increased significantly from 2011 to 2016 (p < 0.01). In 2011, 0.3% (119 of 41,539) patients received linezolid, in 2016 this proportion was significantly higher (0.4%; 255 of 64,412 patients; p < 0.01). In 2016, intensive care units (ICUs) were the wards most frequently prescribing linezolid. The largest proportion of patients receiving linezolid were non-ICU patients. Roughly 38% of linezolid prescriptions were for treatment of skin/soft tissue and respiratory tract infections. In 2016, linezolid was administered parenterally in 70% (n = 179) of cases. Multivariable analysis showed that the ward specialty ICU posed an independent risk factor, while Northern and Southwestern regions in Germany were independent protective factors for a high rate of linezolid prescriptions.

Conclusions

In conclusion, we detected potentials for improving linezolid prescription practices in German hospitals. Given the emergence of linezolid resistance, optimization of linezolid use must be a target of future antimicrobial stewardship activities.

Prevalence of healthcare-associated infections and antimicrobial use in China: Results from the 2018 point prevalence survey in 189 hospitals in Guangdong Province

BACKGROUND

Limited data on healthcare-associated infections (HAIs) are available from the developing world, thus a point prevalence survey was conducted to determine the prevalence of HAIs and antimicrobial use in Guangdong Province, China.

METHODS

A standardized methodology for point prevalence surveys on HAIs and antimicrobial use has been developed by the Chinese Nosocomial Infection Control and Quality Improvement Center. The prevalence of HAIs, antimicrobial use, and baseline hospital-level variables were collected in 189 hospitals from June 2017 to May 2018.

RESULTS

Of 5 868 147 patients, 72 976 had one or more HAIs (1.24%), with 82 700 distinct HAIs. The prevalence rates of device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central line-associated bloodstream infection were 7.92, 2.06, and 0.63 per 1000 catheter-days, respectively. A total of 10 591 (0.18%) HAIs caused by multidrug-resistant organisms were identified. Carbapenem non-susceptibility rates were highest in Acinetobacter species (53.86%) and Pseudomonas aeruginosa (21.60%). Forty-six percent (2 712 258/5 868 147) of inpatients were receiving at least one antimicrobial during this survey.

CONCLUSIONS

This survey indicated the relatively lower prevalence of HAIs but higher antimicrobial using in Guangdong Province compared with other mid to low-income and high-income countries. Further studies are warranted to elucidate which HAI-related indicators are the best measures of HAI performance and thus allow improvements leading to better patient outcomes.

A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan: findings and implications

Background: The extensive use of broad-spectrum antimicrobials in immunocompromised patients is inevitable in situations where culture and sensitivity testing is challenging. However, their overuse leads to an increase in antimicrobial resistance (AMR), which is a growing concern. Method: A repeated point prevalence survey (PPS) was conducted to assess the pattern of antimicrobial prescribing in a specialized cancer care hospital in Pakistan using the methodology employed by the European Centre of Disease Prevention and Control. Results: Out of 313 hospitalized patients, 156 (49.8%) were prescribed one or more antimicrobials, 82 (50.9) in 2017 and 74 (48.7) in 2018. The average bed occupancy in the hospital was 80.3%. Fever in neutropenic patients (20.2%), lower respiratory tract infections (17.8%), and sepsis (14.9%) were the three most common clinical indications. The total number of prescribed antimicrobials was 242, of whom, 41 (16.9%) were given orally and 201 (83.1%) were given parenterally. The most commonly used antimicrobials were piperacillin plus enzyme inhibitor (31.8%), meropenem (7.9%), ceftriaxone (6.2%) and vancomycin (6.2%). Of the total prescribed antimicrobials, 42 (17.3%) antimicrobials were used in surgical departments, 89 (36.8) in adult medical departments, 73 (30.1%) in pediatric medical departments and 38 (15.7) in the intensive care unit (ICU). In addition to these antibacterials, there was relatively high use of antivirals (acyclovir; 4.1%) and antifungals (fluconazole; 3.7%, amphotericin B; 2.9%). Conclusion: The study concluded that broad-spectrum antimicrobial usage in cancer hospitals in Pakistan is high, which can be a risk factor for the emergence of AMR. Repeated PPS is a fruitful way to maintain a focus on inappropriate antimicrobial use and develop pertinent intervention programs targeteing specific issues to improve future use.

A multicenter point prevalence survey of healthcare-associated infections in Pakistan: Findings and implications

BACKGROUND

Healthcare-associated infections (HAIs) are seen as a global public health threat, leading to increased mortality and morbidity as well as costs. However, little is currently known about the prevalence of HAIs in Pakistan. Consequently, this multicenter prevalence survey of HAIs was conducted to assess the prevalence of HAIs in Pakistan.

METHODS

We used the methodology employed by the European Centre for Disease Prevention and Control to assess the prevalence of HAIs in Punjab Province, Pakistan. Data were collected from 13 hospitals using a structured data collection tool.

RESULTS

Out of 1,553 hospitalized patients, 130 (8.4%) had symptoms of HAIs. The most common HAI was surgical site infection (40.0%), followed by bloodstream infection (21.5%), and lower respiratory tract infection (14.6%). The prevalence of HAI was higher in private sector hospitals (25.0%) and among neonates (23.8%) and patients admitted to intensive care units (33.3%). Patients without HAIs were admitted mainly to public sector hospitals and adult medical and surgical wards.

CONCLUSIONS

The study found a high rate of HAIs among hospitals in Pakistan, especially surgical site infections, bloodstream infections, and lower respiratory tract infections. This needs to be addressed to reduce morbidity, mortality, and costs in the future, and further research is planned.

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

OBJECTIVES

In line with the recent global action plan for antimicrobial resistance, this is the first time such a comprehensive antimicrobial point prevalence survey has been undertaken in Pakistan, the sixth most populous country.

METHODS

This point prevalence survey (PPS) was conducted in 13 hospitals among 7 different cities of Pakistan. The survey included all inpatients receiving an antibiotic on the day of PPS. A web-based application was used for data entry, validation, and reporting as designed by the University of Antwerp (www.global-pps.com).

RESULTS

Out of 1954 patients, 1516 (77.6%) were treated with antibiotics. The top three most reported indications for antibiotic use were prophylaxis for obstetrics or gynaecological indications (16.5%), gastrointestinal indications (12.6%) and lower respiratory tract infections (12.0%). The top three most commonly prescribed antibiotics were ceftriaxone (35.0%), metronidazole (16.0%) and ciprofloxacin (6.0%). Out of the total indications, 34.2% of antibiotics were prescribed for community-acquired infections (CAI), 5.9% for healthcare-associated infections (HAI), and 57.4% for either surgical or medical prophylaxis. Of the total use for surgical prophylaxis, 97.4% of antibiotics were given for more than one day.

CONCLUSIONS

Unnecessary prophylactic antibiotic use is extremely high, and broad-spectrum prescribing is common among hospitals in Pakistan. There is an urgent need to work on the  national action plan of Pakistan on antibiotic resistance to address this.

Burden of healthcare-associated infections in European acute care hospitals

Point prevalence surveys of healthcare-associated infections (HAI) and antimicrobial use in the European Union and European Economic Area (EU/EEA) from 2016 to 2017 included 310,755 patients from 1,209 acute care hospitals in 28 countries. After national validation, we estimated that 6.5% (cumulative 95% confidence interval (cCI): 5.4-7.8%) patients in acute care hospitals had at least one HAI (country-weighted prevalence). On any given day, 98,166 patients (95% cCI: 81,022-117,484) in acute care hospitals had an HAI; 3.8 million (95% cCI: 3.1-4.5 million) patients acquired an HAI each year. Our study confirmed a high annual number of HAI in healthcare facilities in the EU/EEA.

Development of case vignettes for assessment of the inter-rater variability of national validation teams for the point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals

BACKGROUND

In 2016-17 the European Centre for Disease Prevention and Control (ECDC) organized the second point prevalence survey (PPS) of healthcare-associated infections (HCAIs) and antimicrobial use in European acute care hospitals. This survey included a validation study to maximize the accuracy of case identification and classification.

AIM

ECDC developed case vignettes to assess the performance of the national validation teams.

METHODS

Case vignettes were developed by two medical doctors with experience in the management of HCAIs and antimicrobial stewardship. The case vignettes were based on actual clinical cases. The distribution of HCAIs among the case vignettes reflected the distribution of HCAIs in the previous PPS. All case vignettes were pilot-tested by three expert raters. Agreement among the expert raters was measured using kappa statistics.

FINDINGS

Sixty case vignettes were developed. Twenty-nine of them were HCAI cases and 31 were cases without an HCAI. The inter-rater reliability using kappa statistics was 0.78 for the presence of HCAI and 0.89 for the antimicrobial use, respectively.

CONCLUSION

The agreement between the expert raters was very good for antimicrobial use and good for the presence of HCAI. Case vignettes can be a tool to support standardization of surveillance, improving the validity and comparability of the data.

Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship

OBJECTIVES

Antimicrobial prescribing practices and use contribute to the growing threat of antimicrobial resistance (AMR) to global health. Information on antimicrobial prescribing and use are lacking in most developing countries, including Nigeria. This information is crucial for antimicrobial stewardship programmes, an effective tool in minimising AMR. This study was performed to gather baseline information on antimicrobial prescribing practices in Nigeria.

METHODS

A cross-sectional survey was conducted on all inpatients of a tertiary hospital in South East Nigeria. All patients on admission on the day of the survey formed the study population. A standardised questionnaire, web-based data entry and validation process designed by the University of Antwerp, Belgium, were adopted. Information on basic patient demographics, antimicrobial agents used, indication for treatment, laboratory data prior to treatment and stop/review date was collected.

RESULTS

Of 220 inpatients surveyed, 78.2% were receiving at least one antimicrobial agent. The highest prevalence of antimicrobial use was in the ICU (100%), adult surgical ward (82.9%) and paediatric medical ward (82.9%). Agents used were mainly third-generation cephalosporins (ceftriaxone 25.1%) and nitroimidazole (metronidazole 24.6%). Antimicrobial prescription was empirical (91.1% in medical wards, 96.8% in surgical wards and 100% in ICU). There was limited use of guidelines but clear documentation of stop/review dates and reasons for antimicrobial use.

CONCLUSION

Although a majority of antimicrobial prescriptions were made with indications, they were mostly prescribed empirically and the majority of prescriptions were parenteral formulations. There is a need to develop antibiotic guidelines, to educate prescribers on antimicrobial stewardship and to encourage targeted prescription.

Point prevalence survey of peripheral venous catheter usage in a large tertiary care university hospital in Germany

Background

Bloodstream infections (BSI) are among the most frequently documented healthcare-associated infections (HAI). Central and peripheral venous catheters (CVC and PVC) are relevant risk factors for BSI. Although the risk for BSI is higher for CVC, PVC are utilized more frequently and are therefore relevant in the context of HAI prevention. Robust data on the prevalence of PVC and associated infections in German hospitals are scarce to this date. The objectives of this survey were to estimate the prevalence of PVC and PVC-associated infections on peripheral wards of a large tertiary care hospital in Germany. The collected data may be utilized for a tailored infection prevention intervention in the future.

Methods

A point prevalence survey was conducted on peripheral wards of a tertiary care hospital with more than 3.000 beds. Data were collected between August 2017 and February 2018. Standardized data collection forms were used for collecting ward, patient and PVC-related data. As endpoints, prevalence of patients with PVC, PVC-associated infections and PVC without usage in the 24 h prior to the survey and without documentation of intended usage in the 24 h after the survey ("unused PVC") were chosen. For data analysis, Kruskal-Wallis test was employed for continuous variables and Chi-squared test or Fisher's exact test for categorical variables. Multivariable analysis and logistic regression were performed for the endpoint unused PVC.

Results

Data from 2.092 patients on 110 wards were collected. The overall prevalence of patients with PVC was 33%. Infections were recorded in 16 patients. Except one case of BSI, these were all local infections at the site of insertion. Of 725 documented PVC, 77 (11%) were unused PVC. Multivariate analysis and logistic regression revealed wards with the practice of regularly obtaining blood from PVC, PVC with dirty or loose insertion dressing, pediatric ward specialty and last inspection of the PVC more than 1 day ago as significant risk factors for unused PVC.

Conclusions

A substantial proportion of patients presented with a PVC on the day of survey. Too few infections were recorded to allow for more detailed analyses. Various risk factors for unused PVC were identified. We hereby present a solid method to obtain an overview about PVC use and to increase awareness for PVC-associated risks. The limitations of point prevalence surveys have to be recognized.

Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan

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.

Point prevalence survey of antibiotic use in 26 Saudi hospitals in 2016

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.

Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey

OBJECTIVES

The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey.

METHODS

A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed.

RESULTS

A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies.

CONCLUSION

The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital.

Point prevalence surveys of antimicrobial use among eight neonatal intensive care units in India: 2016

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.

Development and evaluation of a website for surveillance of healthcare-associated urinary tract infections in Australia

Phase II of the Surveillance to Reduce Urinary Tract Infections project piloted a website for point prevalence surveys of healthcare-associated (HAUTI) and catheter-associated urinary tract infection in Australian hospitals and aged care homes. This report describes development and evaluation of the website for online data collection. Evaluation findings from 38 data collectors indicated that most respondents found website registration and web form use easy (N = 22; 58% and N = 16; 43%, respectively). The need for improved computer literacy skills and automated data systems were highlighted. This study demonstrated a novel approach for Australian HAUTI data collection; however, refinements are needed before national roll-out.

Point prevalence surveys on healthcare acquired infections in medical and surgical wards of a teaching hospital in Rome

BACKGROUND

Healthcare acquired infections (HAI) are an important cause of morbidity and mortality in hospitals worldwide. Aim of the study was to analyze nine years surveillance activity, carried out by point prevalence surveys from 2007 to 2015, in a 450-bed teaching hospital in Rome.

METHODS

Point prevalence surveys were carried out every year in the medical and surgical wards following the same methodology. In accordance with definitions used by the Centers for Disease Control, all infections occurred more than 48 hours after hospital admission were considered HAI, and included in the study. Baseline characteristics, clinical features, isolated pathogens (only for the period 2011-2015) and antimicrobial resistance were recorded.

RESULTS

During the nine years point prevalence surveys a total 2,840 patients were enrolled. Overall 136 (4.79%) patients developed 180 (6.34%) HAI. The most frequent HAI were respiratory tract infections (RTI), which accounted for 35.0% of all HAI, followed by surgical site infections (SSI) 22.2%, urinary tract infections (UTI) 19.4%, bloodstream infections (BSI) 17.2%, and others 6.1%. HAI related to major invasive risk procedures were also evaluated. SSI/patients undergoing surgery 3.99%, UTI/ patients with urinary catheter 4.17% and BSI/patients with CVC 9.42%. Over one-half of all patients surveyed (1,532, 53.9%) were receiving antibiotics at the time of our study. Among them 892 (58.2%) for treatment, 641 (41.8%) for prophylaxis. In the latter group, 109 (17.0%) underwent extra-short term, 89 (13.9%) short term and 443 (69.1%) a long term prophylaxis. During the period 2011-2015 out of 110 HAI episodes 71 (64.5%) were confirmed microbiologically. In total 106 pathogens were isolates, Gram-negative bacteria (63.2%) were isolated more frequently than Gram-positive bacteria (28.3%).

CONCLUSIONS

The overall HAI prevalence in our hospital was consistent with those reported in other studies in Italy. The study underlined the role of Gram-negative bacteria in HAI and the need for antimicrobial stewardship. It also provided useful baseline data for rational priorities in allocation of resources, for further infection control activities.