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Khursheed N, Ahsan Q, Rattani S, Fatima M, Raza A, Tariq S, Mustafa T, Ahmed K, Iqbal S, Zulfiqar S, Ahmed SM, Fatima G, Akbar Khan S, Ullah F, Ahmed RA, Jamal S. Point prevalence probing of antimicrobial prescription patterns from a developing country. Expert Rev Anti Infect Ther 2023:1-8. [PMID: 37712527 DOI: 10.1080/14787210.2023.2259098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Irrational use of antibiotics intensifies resistance and jeopardizes advances made in modern medicine. We aimed to conduct a baseline gap analysis survey on antibiotic prescription practices across Pakistan. RESEARCH DESIGN AND METHODS This multi-centered cross-sectional survey was conducted at six public sector tertiary care hospitals from February 2021 to March 2021. Data related to various variables including hospital infrastructure, policies and practices, monitoring and feedback, and epidemiological, clinical, and antibiotic prescription for surveyed patients was collected using World Health Organization (WHO) Point Prevalence Survey (PPS) methodology. RESULTS In a survey of 837 inpatients, 78.5% were prescribed antibiotics. Most commonly prescribed antimicrobial was ceftriaxone (21.7%), followed by metronidazole (17.3%), cefoperazone-sulbactam (8.4%), amoxicillin-clavulanate (6.3%), and piperacillin/tazobactam (5.9%). Surgical prophylaxis (36.7%) and community-acquired infections (24.7%) were the main reasons for antibiotic prescriptions. Single antibiotics were given to 46.7% of patients, 39.9% received a combination of two antibiotics, and 12.5% were prescribed three or more antibiotics. Among six hospitals surveyed, two had drug and therapeutic committees, three had infection prevention and control committees, and one had an antibiotic formulary. CONCLUSION Findings demonstrate high consumption of broad-spectrum antimicrobials and emphasize the importance of expanding antimicrobial stewardship programs among hospitals. Mentoring clinical teams could help rationalize antimicrobial use.
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Affiliation(s)
- Nazia Khursheed
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Qadeer Ahsan
- DAI - Fleming Fund Country Grant, Islamabad, Pakistan
| | - Salima Rattani
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Madeeha Fatima
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Ali Raza
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Saba Tariq
- DAI - Fleming Fund Country Grant, Islamabad, Pakistan
| | | | - Kamran Ahmed
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | - Sadia Iqbal
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
| | | | | | - Ghulam Fatima
- Dr Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | | | - Farman Ullah
- Provincial Head Quarter Hospital, Gilgit, Pakistan
| | | | - Saba Jamal
- Indus Hospital and Health Network, Fleming Fund Country Grant, Karachi, Pakistan
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Chetty T, Pillay A, Balakrishna Y, Reddy T, Goga A, Moore DP, Karsas M, Cloete J, Archary M, Kwawegen AV, Thomas R, Nakwa FL, Waggie Z, Magrath S, Jeena P. Healthcare-Associated Infections Drive Antimicrobial Prescribing in Pediatric Departments at Three Academic Hospitals in South Africa. Pediatr Infect Dis J 2023; Publish Ahead of Print:00006454-990000000-00494. [PMID: 37368998 DOI: 10.1097/inf.0000000000003954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The prevalence of antimicrobial prescriptions for healthcare-associated infections (HAI) in South Africa is largely unknown. This study aimed to estimate the point prevalence of pediatric antibiotic and antifungal usage in 3 South African academic hospitals. METHODS This cross-sectional study included hospitalized neonates and children (0-15 years). We used the World Health Organization methodology for antimicrobial point prevalence studies, with weekly surveys to achieve a sample size of ~400 at each site. RESULTS Overall, 1,946 antimicrobials were prescribed to 1,191 patients. At least 1 antimicrobial was prescribed for 22.9% [95% confidence interval (CI): 15.5-32.5%] of patients. The prevalence of antimicrobial prescribing for HAI was 45.6%. In the multivariable analysis, relative to children 6-12 years, neonates [adjusted relative risk (aRR): 1.64; 95% CI: 1.06-2.53], infants (aRR: 1.57; 95% CI: 1.12-2.21) and adolescents (aRR: 2.18; 95% CI: 1.45-3.29) had significantly increased risk of prescriptions for HAI. Being preterm (aRR: 1.33; 95% CI: 1.04-1.70) and underweight (aRR: 1.25; 95% CI: 1.01-1.54) was predictive of antimicrobial usage for HAI. Having an indwelling device, surgery since admission, blood transfusions and classification as rapidly fatal on McCabe score also increased the risk of prescriptions for HAI. CONCLUSIONS The high prevalence of antimicrobial prescribing for HAI to treat children with recognized risk factors in academic hospitals in South Africa is concerning. Concerted efforts need to be made to strengthen hospital-level infection prevention and control measures, with a critical review of antimicrobial usage through functional antibiotic stewardship programs to preserve the available antimicrobial armamentarium at the hospital level.
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Affiliation(s)
- Terusha Chetty
- From the HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, South Africa
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - David P Moore
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccine and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Karsas
- Department of Pediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Jeané Cloete
- Maternal and Infant Health Care Strategies Research Unit Centre, University of Pretoria, Pretoria, South Africa
| | - Moherndran Archary
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alison van Kwawegen
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Zainab Waggie
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Magrath
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Prakash Jeena
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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Mittal N, Mittal R, Goel N, Parmar A, Bahl A, Kaur S, Gudibanda KR, Dudhraj V, Singh SK. WHO-Point Prevalence Survey of Antibiotic Use Among Inpatients at a Core National Antimicrobial Consumption Network Site in North India: Findings and Implications. Microb Drug Resist 2023; 29:1-9. [PMID: 36656989 DOI: 10.1089/mdr.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Data on Point Prevalence Surveys (PPSs) in India are limited yet. We report findings of a PPS conducted in a core "National Antimicrobial Consumption Network site" under National Centre for Disease Control - WHO project "Point prevalence survey of antimicrobial consumption at healthcare facilities." A cross-sectional survey was conducted as per the "WHO methodology for PPS on antibiotic use in hospitals" in a tertiary care hospital in India in December 2021. Data were collected using predesigned and pretested questionnaire in separate hospital, ward, and patient forms. Eight hundred two inpatients (excluding ICUs) were covered out of whom 299 (37.3%) were on antibiotics with 11.7% receiving 3 or more antibiotics. Surgical prophylaxis (SP) (42.5%) and community acquired infections (32.8%) were the most common indications for antibiotic use. Of the patients, 92.5% received SP for more than 24 hrs. Most commonly prescribed antibiotics were penicillins with beta-lactamase inhibitors (22.3%). Of the total antibiotic prescriptions, 81.5% were from WHO essential medicines list and 12% from "not recommended" WHO AWaRe classification. Of the antibiotic prescriptions, 84.6% were parenteral. Few prescriptions complied with standard treatment guidelines (1.9%), documented indication for antibiotic use (11.6%), and stop/review date (4.4%) in notes. Double anaerobic cover accounted for 6.8% of the total prescriptions. Some identified areas for improvement were: formulation of hospital antibiotic guidelines, promoting culture of sending cultures, improvement in surgical antibiotic prophylaxis, decreasing use of antibiotic combinations and double anaerobic cover, fostering IV to oral switch of antibiotics, and ensuring effective communication among health care workers by documenting adequate information in medical notes.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology and Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Rakesh Mittal
- Department of Pharmacology and Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Nidhi Goel
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Aparna Parmar
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Arti Bahl
- National Center for Disease Control (NCDC), New Delhi, India
| | - Suneet Kaur
- National Center for Disease Control (NCDC), New Delhi, India
| | | | - Vibhor Dudhraj
- National Center for Disease Control (NCDC), New Delhi, India
| | - Sujeet K Singh
- National Center for Disease Control (NCDC), New Delhi, India
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Pei X, Gao Y, Kou Y, Ding Y, Li D, Lei P, Zuo L, Liu Q, Miao N, Reddy S, Yu Y, Sun X. Association of necrotizing enterocolitis with antimicrobial exposure in preterm infants <32 weeks gestational age:A multicenter prospective case-control study. Front Pharmacol 2022; 13:976487. [PMID: 36210827 PMCID: PMC9537687 DOI: 10.3389/fphar.2022.976487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess the risk of necrotizing enterocolitis (NEC) and explore the relationship between antibiotic overexposure and disease occurrence in a large prospective birth cohort.Methods: Based on a prospective birth cohort, the study collected hospitalization data of very preterm infants (VPIs) having gestational age of less than 32 weeks from January 1, 2018, to June 30, 2021 via the China Northern Neonatal Network. Infants diagnosed with NEC ≥ stage II were included in the case group, and each case was matched for GA and birth weight for the control group. Furthermore, the risk factors for NEC were determined by statistical analyses.Results: A total of 6425 VPIs were included in this study, and 167 (2.6%) of these subjects were diagnosed with NEC ≥ stage II. The study also included 984 extremely preterm infants (gestational age <28 weeks), including 50 (5.1%) infants diagnosed with NEC ≥ stage II. In the matched case-control study, subjects had a total of antibiotic days-of-therapy for 9015 days, of which broad-spectrum antibiotics (BSAs) accounted for 77%. The antibiotic spectrum index per antibiotic day in the case group was significantly higher and was an independent risk factor for the occurrence of NEC (p = 0.001, OR = 1.13).Conclusion: The cohort of VPIs was overexposed to antiboitics. Unreasonable combination of antibiotics and overexposure to BSAs may increase the risk of NEC in preterm infants.
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Affiliation(s)
- Xiaojing Pei
- Department of Neonatology, Linyi People’s Hospital, Linyi, China
| | - Yujun Gao
- Department of Neonatology, Baogang Third Hospital of Hongci Group, Baotou, China
| | - Yan Kou
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yanjie Ding
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, China
| | - Dan Li
- Department of Neonatology, Liaocheng People’s Hospital, Liaocheng, China
| | - Peng Lei
- Department of Neonatology, Jinan Maternity and Child Care Hospital, Jinan, China
| | - Lili Zuo
- Department of Neonatology, Zibo Maternity and Child Care Hospital, Zibo, China
| | - Qiongyu Liu
- Department of Neonatology, Women and Children’s Healthcare Hospital of Linyi, Linyi, China
| | - Naiying Miao
- Department of Neonatology, Hebei Petro China Central Hospital, Hebei, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Yonghui Yu, ; Xuemei Sun,
| | - Xuemei Sun
- Department of Neonatology, Linyi People’s Hospital, Linyi, China
- *Correspondence: Yonghui Yu, ; Xuemei Sun,
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Kaur H, Krishnamoorthi S, Dhaliwal N, Biswal M, Singh S, Muthu V, Rudramurthy SM, Agarwal R, Ghoshal S, Singh S, Malhotra P, Jain S, Samujh R, Ghosh A, Chakrabarti A. Antifungal prescription practices and consumption in a tertiary care hospital of a developing country. Mycoses 2022; 65:935-945. [PMID: 35934811 DOI: 10.1111/myc.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antifungal stewardship is a less explored component of antimicrobial stewardship programmes, especially in developing countries. OBJECTIVE We aimed to determine antifungal prescription practices in a tertiary centre of a developing country to identify the challenges for antifungal stewardship programmes. METHODS Four single-day point prevalent surveys were performed in inpatient units and data were collected from medical records. Antifungal use was recorded in terms of consumption, therapeutic strategies and appropriateness. RESULTS We found a 2.42%-point prevalence of antifungal prescriptions. Antifungal use was higher in children than adults (4.1% vs. 2.03%), medical than surgical units (3.7% vs. 1.24%) and ICUs than general wards (5.8% vs. 1.9%). The highest antifungal use was observed in the haematology-oncology units (29.3%) followed by emergency (16.2%) and gastroenterology units (11.6%). Among 215 prescriptions, amphotericin B was the most commonly prescribed (50.2%) followed by fluconazole (31.6%). The targeted antifungal therapy was practised more commonly (31.5%) than empiric (29.1%), pre-emptive (22.6%) and prophylactic (16.8%) therapy. Amphotericin B was commonly used for pre-emptive (p = .001) and targeted (p = .049) therapy, while fluconazole (p = .001) and voriconazole (p = .011) for prophylaxis. The prescriptions were inappropriate in 25.1% due to the wrong choice of antifungal (44.4%), indication (27.7%) and dosage (24%). The overall mean antifungal consumption was 2.71 DDD/1000 PD and 8.96 DOT/1000 PD. CONCLUSIONS We report here the low prevalence of antifungal use at a tertiary care centre in a developing country. Though training for antifungal use would be important for antifungal stewardship, the challenge would remain with the affordability of antifungals.
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Affiliation(s)
- Harsimran Kaur
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Navneet Dhaliwal
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shreya Singh
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Department of Paediatric Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Hematology & Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Paediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Ghosh
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children’s Hospitals in Punjab, Pakistan. Antibiotics (Basel) 2022; 11:antibiotics11081056. [PMID: 36009925 PMCID: PMC9405424 DOI: 10.3390/antibiotics11081056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023] Open
Abstract
Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups including neonates and children. A point prevalence survey (PPS) was conducted among three tertiary care children’s hospitals in the Punjab province using the World Health Organization (WHO) methodology. Antibiotic use was documented according to the WHO AWaRe classification. Out of a total of 1576 neonates and children, 1506 were prescribed antibiotics on the day of the survey (prevalence = 95.5%), with an average of 1.9 antibiotics per patient. The majority of antibiotics were prescribed in the medical ward (75%), followed by surgical ward (12.8%). Furthermore, 56% of antibiotics were prescribed prophylactically, with most of the antibiotics (92.3%) administered via the parenteral route. The top three indications for antibiotics were respiratory tract infections (34.8%), gastrointestinal infections (15.8%), and prophylaxis for medical problems (14.3%). The three most common antibiotics prescribed were ceftriaxone (25.8%), amikacin (9.2%), and vancomycin (7.9%). Overall, 76.6% of the prescribed antibiotics were from Watch category followed by 21.6% from the Access group. There was a very high prevalence of antibiotic use among hospitalized neonates and children in this study. Urgent measures are needed to engage all the stakeholders to formulate effective ASPs in Pakistan, especially surrounding Watch antibiotics.
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7
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Sharif M, Aslam S, Saleem Z. Point prevalence survey to estimate antimicrobial use in a tertiary care university hospital in Pakistan using WHO methodology: findings and implications. Infect Dis (Lond) 2022; 54:698-701. [PMID: 35439103 DOI: 10.1080/23744235.2022.2064544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Muhammad Sharif
- King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Sana Aslam
- King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
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8
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Bansal A, Sharma R, Prakash R. Adoption of the World Health Organization access, watch reserve index to evaluate and monitor the use of antibiotics at a tertiary care hospital in India. Perspect Clin Res 2022; 13:90-93. [PMID: 35573458 PMCID: PMC9106137 DOI: 10.4103/picr.picr_202_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization classification of antibiotics classifies key antibiotics into access, watch, and reserve (AWaRe) categories. Categorization provides a novel metrics called "AWaRe index" to study and monitor antibiotic consumption globally and within the same setting over time. Aim The aim of this study is to compare the use of antibiotics in 2 years using the AWaRe index tool. Materials and Methods A retrospective study was conducted in SMS Hospital, Jaipur to collect data regarding total antibiotics consumed between January 2017 and December 2018 from drug distribution centers in hospital premises using the AWaRe classification. Data were then compared on yearly basis. Results In 2017, 53.31% of antibiotics consumed belonged to access, 40.09% to watch, and 3.40% to reserve category, respectively, as compared to 41.21%, 46.94%, and 8.15%, respectively, in 2018. Conclusion Increased use of watch (17%) and reserve antibiotics (140%) over 1 year with the same infection scenario in a similar setting indicates resistance in evolution.
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Affiliation(s)
- Alka Bansal
- Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India
| | - Rajni Sharma
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
| | - Ravi Prakash
- Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
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9
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Oo WT, Carr SD, Marchello CS, San MM, Oo AT, Oo KM, Lwin KT, Win HH, Crump JA. Point-prevalence surveys of antimicrobial consumption and resistance at a paediatric and an adult tertiary referral hospital in Yangon, Myanmar. Infect Prev Pract 2022; 4:100197. [PMID: 35005602 PMCID: PMC8717234 DOI: 10.1016/j.infpip.2021.100197] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is increasingly prevalent worldwide. The inappropriate use of antimicrobials, including in the hospital setting, is considered a major driver of antimicrobial resistance. AIM To inform improvements in antimicrobial stewardship, we undertook point prevalence surveys of antimicrobial prescribing at Yangon Children's Hospital and Yangon General Hospital in Yangon, Myanmar. METHODS We conducted our surveys using the Global Point-Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) method. All inpatients who were prescribed an antimicrobial on the day of the survey were included in the analysis. FINDINGS We evaluated a total of 1,980 patients admitted to two hospitals during December 2019. Of these, 1,255 (63.4%) patients were prescribed a total of 2,108 antimicrobials. Among antimicrobials prescribed, 722 (34.3%) were third-generation cephalosporins, the most commonly prescribed antimicrobial class. A total of 940 (44.6%) antimicrobials were prescribed for community-acquired infection, and 724 (34.3%) for surgical prophylaxis. Of 2,108 antimicrobials, 317 (15.0%) were prescribed for gastrointestinal tract prophylaxis, 305 (14.5%) for skin, soft tissue, bone and joint prophylaxis, and 303 (14.4%) for pneumonia treatment. A stop or review date was documented for 350 (16.6%) antimicrobial prescriptions, 673 (31.9%) antimicrobial prescriptions were guideline compliant, and 1,335 (63.3%) antimicrobials were administered via the parenteral route. Of 1,083 antimicrobials prescribed for a therapeutic use, 221 (20.4%) were targeted therapy. CONCLUSION Our findings underscore the need to update and expand evidence-based guidelines for antimicrobial use, promote the benefits of targeted antimicrobial therapy, and support the implementation of hospital-based antimicrobial stewardship programmes at the hospitals surveyed.
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Affiliation(s)
- Win Thandar Oo
- Centre for International Health, University of Otago, Dunedin, New Zealand
- Department of Microbiology, University of Medicine 1, Yangon, Myanmar
| | - Samuel D. Carr
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Moe Moe San
- Department of Tropical and Infectious Diseases Medicine, Yangon General Hospital, Yangon, Myanmar
| | | | - Khine Mar Oo
- Department of Microbiology, University of Medicine 1, Yangon, Myanmar
| | - Kay Thi Lwin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
| | - Hla Hla Win
- University of Public Health, Yangon, Myanmar
| | - John A. Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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10
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Zhang J, Ma X, Tang L, Tian D, Lin L, Li Y, Lu G, Si L, Zhang W, Qian J, Wu L, Liu G, Li W, Cao Q, Wu K, Zheng Y, Deng J, Yang Y. Pattern of Antibiotic Prescriptions in Chinese Children, A Cross-Sectional Survey From 17 Hospitals Located Across 10 Provinces of China. Front Pediatr 2022; 10:857945. [PMID: 37152767 PMCID: PMC10155817 DOI: 10.3389/fped.2022.857945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 05/09/2023] Open
Abstract
Objectives Use of Broad-spectrum antibiotics is related closely to increasing antimicrobial resistance. Reports on antibiotic prescriptions for Chinese children were rare. We described the prescribing patterns of antibiotic prescriptions for Chinese children from 2017 to 2019 based on the Anatomical Therapeutic Chemical Classification (ATC classification); the Access, Watch, and Reserve (AWaRe) classification from the World Health Organization (WHO), and the Management of Antibiotic Classification in China. Methods A 1-day point-prevalence survey (PPSs) on antibiotics prescribing for Chinese children was conducted in hospitalized children from 17 centers in 10 Chinese provinces from 1 September 2017 to 30 November 2019. Results A total of 4,982 antibiotic prescriptions for Chinese children were included in the analysis. There were 76 types of antibiotic agents in total, 22 (28.9%) of which accounted for 90% of all antibiotic prescriptions. The top-three antibiotics prescribed for children were azithromycin (684, 13.7%), ceftriaxone (508, 10.2%) and latamoxef (403, 8.1%). Third-generation cephalosporins (1,913, 38.4%) were the most commonly prescribed antibiotic classes. On the basis of the AWaRe classification, the Watch group antibiotics accounted for 76.3% and Access group antibiotics accounted for 12.1% of all antibiotic prescriptions. On the basis of the China classification, we showed that 26.5% of antibiotic prescriptions were in the Unrestricted group, 53.6% in the Restricted group, and 14.5% in the Special group. Conclusion The proportion of antibiotics included in the Watch group and the Special group was high in children in China. The AWaRe classification and China classification for antibiotic prescriptions could be used to supply detailed data for antibiotic stewardship as a simple metric.
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Affiliation(s)
- Jiaosheng Zhang
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiang Ma
- Department of Respiratory, Jinan Children's Hospital and Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lanfang Tang
- Department of Respiratory, Children's Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Daiyin Tian
- Department of Respiratory, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Lin
- Department of Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanqi Li
- Department of Respiratory, Xi'an Children's Hospital, Xi'An, China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ligang Si
- Department of Respiratory, The First Hospital of Haerbin Medical University, Harbin, China
| | - Wenshuang Zhang
- Department of Respiratory, Tianjin Children's Hospital, Tianjin, China
| | - Jing Qian
- Department of Respiratory, Children's Hospital Attached to The Capital Institute of Pediatrics, Beijing, China
| | - Lijuan Wu
- Clinical Laboratory, Bao'an Maternity and Child Health Hospital, Shenzhen, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wei Li
- Department of Pediatric Respiratory, The First Hospital of Jilin University, Changchun, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Keye Wu
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhan, China
| | - Yuejie Zheng
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
- *Correspondence: Jikui Deng
| | - Yonghong Yang
- Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, Department of Internal Medicine, Shenzhen Children's Hospital, Beijing, China
- Yonghong Yang
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Haque M, Godman B, Sharma P, Chowdhury K, Kumar S, Bhatt R, Hirani T, Duseja S, Lutfor A, Etando A, Škrbić R, Shahwan M, Jairoun A. A pilot study regarding the consequences of the COVID-19 pandemic on healthcare education in India and the implications. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_34_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Haseeb A, Faidah HS, Algethamy M, Alghamdi S, Alhazmi GA, Alshomrani AO, Alqethami BR, Alotibi HS, Almutiri MZ, Almuqati KS, Albishi AA, Elrggal ME, Mahrous AJ, Khogeer AA, Saleem Z, Iqbal MS, Sheikh A. Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010254. [PMID: 35010512 PMCID: PMC8782433 DOI: 10.3390/ijerph19010254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
(1) Background: Inappropriate use of antimicrobials and subsequently rise of antimicrobial resistance (AMR) remains a major public health priority. Over-prescribing of broad-spectrum antibiotics is one of the main contributing factors for the emergence of AMR. We sought to describe antimicrobial prescribing trends among patients in public hospitals in Makkah hospitals. (2) Method: We undertook a point prevalence survey (PPS) in six hospitals in Makkah, Saudi Arabia, from January 2019 to July 2019. The survey included all the inpatients receiving antimicrobials on the day of PPS. Data was collected using the Global point prevalence survey (PPS) tool developed by the University of Antwerp, Belgium. (3) Results: Of 710 hospitalized patients, 447 patients (61.9%) were treated with one or more antimicrobials during the study period. The average bed occupancy among six hospitals was 74.4%. The majority of patients received antimicrobials parenterally (90.3%). Of the total prescribed antimicrobials, 415 (53.7%) antimicrobials were used in medical departments, 183 (23.7%) in surgical departments, and 175 (22.6%) in ICUs. Pneumonia (17.3%), skin and soft tissue infections (10.9%), and sepsis (6.6.%) were three common clinical indications. Ceftriaxones were the most commonly used antibiotics that were prescribed in 116 (15%) of patients, followed by piperacillin, with an enzyme inhibitor in 84 (10.9%). (4) Conclusion: There was a high prevalence of antibiotic use in the hospitals of Makkah, which could be a potential risk factor for the incidence of resistant strains, particularly MRSA infection. Public health decision-makers should take these findings into consideration to update national policies for antibiotic use in order to reduce the risks of further increases of AMR.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.J.M.)
- Correspondence: ; Tel.: +966-568560776
| | - Hani Saleh Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Makkah 21955, Saudi Arabia;
| | - Manal Algethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia;
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 65779, Saudi Arabia;
| | - Ghaidaa Ali Alhazmi
- Departments of Pharmacy, King Abdullah Medical City, Ministry of Health, Makkah 21955, Saudi Arabia;
| | - Afnan Owedah Alshomrani
- King Abdul Aziz Medical City, WR, Jeddah, Ministry of National Guard, Jeddah 21423, Saudi Arabia;
| | | | - Hind Saeed Alotibi
- Prince Meshari Bin Saud- General Baljarshi Hospital, Al Baha 65779, Saudi Arabia;
| | | | - Khawlah Saad Almuqati
- King Faisal Specialist Hospital and Research Centre (Gen. Org.), Riyadh 11211, Saudi Arabia;
| | | | - Mahmoud Essam Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.J.M.)
| | - Ahmad Jamal Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia; (M.E.E.); (A.J.M.)
| | - Asim Abdulaziz Khogeer
- Plan and Research Department, General Directorate of Health Affairs of Makkah Region, Ministry of Health, Makkah 21955, Saudi Arabia;
- Medical Genetics Unit, Maternity and Children Hospital, Makkah Healthcare Cluster, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, New Campus, The University of Lahore, Lahore 54000, Pakistan;
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia;
| | - Aziz Sheikh
- Usher Institute, Old Medical School, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK;
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Mathur P, Sanyal D, Callahan DL, Conlan XA, Pfeffer FM. Treatment technologies to mitigate the harmful effects of recalcitrant fluoroquinolone antibiotics on the environ- ment and human health. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 291:118233. [PMID: 34582925 DOI: 10.1016/j.envpol.2021.118233] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
Antibiotic proliferation in the environment and their persistent nature is an issue of global concern as they induce antibiotic resistance threatening both human health and the ecosystem. Antibiotics have therefore been categorized as emerging pollutants. Fluoroquinolone (FQs) antibiotics are an emerging class of contaminants that are used extensively in human and veterinary medicine. The recalcitrant nature of fluoroquinolones has led to their presence in wastewater, effluents and water bodies. Even at a low concentration, FQs can stimulate antibacterial resistance. The main sources of FQ contamination include waste from pharmaceutical manufacturing industries, hospitals and households that ultimately reaches the wastewater treatment plants (WWTPs). The conventional WWTPs are unable to completely remove FQs due to their chemical stability. Therefore, the development and implementation of more efficient, economical, convenient treatment and removal technologies are needed to adequately address the issue. This review provides an overview of the technologies available for the removal of fluoroquinolone antibiotics from wastewater including adsorptive removal, advanced oxidation processes, removal using non-carbon based nanomaterials, microbial degradation and enzymatic degradation. Each treatment technology is discussed on its merits and limitations and a comparative view is presented on the choice of an advanced treatment process for future studies and implementation. A discussion on the commercialization potential and eco-friendliness of each technology is also included in the review. The importance of metabolite identification and their residual toxicity determination has been emphasized. The last section of the review provides an overview of the policy interventions and regulatory frameworks that aid in retrofitting antibiotics as a central key focus contaminant and thereby defining the discharge limits for antibiotics and establishing safe manufacturing practices.
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Affiliation(s)
- Purvi Mathur
- TERI-Deakin NanoBiotechnology Centre, Sustainable Agriculture Division, The Energy and Resources Institute, New Delhi, 110003, India; Deakin University, School of Life and Environmental Sciences (Burwood Campus), 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Doyeli Sanyal
- TERI-Deakin NanoBiotechnology Centre, Sustainable Agriculture Division, The Energy and Resources Institute, New Delhi, 110003, India; Amity University Punjab, IT City, Sector 82A, Mohali, 140308, India.
| | - Damien L Callahan
- Deakin University, School of Life and Environmental Sciences (Burwood Campus), 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Xavier A Conlan
- Deakin University, School of Life and Environmental Sciences, (Waurn Ponds Campus), 75 Pigdons Road, Locked Bag 20000, Geelong, VIC, 3220, Australia
| | - Frederick M Pfeffer
- Deakin University, School of Life and Environmental Sciences, (Waurn Ponds Campus), 75 Pigdons Road, Locked Bag 20000, Geelong, VIC, 3220, Australia
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A national, multicentre web-based point prevalence survey of antimicrobial use and quality indices among hospitalised paediatric patients across South Africa. J Glob Antimicrob Resist 2021; 29:542-550. [PMID: 34915203 DOI: 10.1016/j.jgar.2021.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Data on antimicrobial consumption among the paediatric population in public hospitals in South Africa is limited. These needs to be addressed to improve future use and reduce antimicrobial resistance rates. Consequently, the objective is to quantify antimicrobial usage;and identify and classify which antimicrobials are used in the peadiatric population in public sector hospitals in South Africa according to World Health Organiosation (WHO) AWaRe list of antimicrobials METHODS: Conduct a point prevalence survey among 18 public sector hospitals from nine provinces using a newly developed web-based application. The data will be analysed according to the WHO AwaRe list to guide future quality improvement programmes. RESULTS 1261 paediatric patient files were reviewed with 49.7% (627/1261) receiving at least one antimicrobial, with 1013 antimicrobials prescribed overall. The top five antimicrobials included ampicillin (16.4%), gentamycin (10.0%), amoxicillin and enzyme inhibitor (9.6%), ceftriaxone (7.4%), and amikacin (6.3%). Antimicrobials from the Access classification were the most used (55.9%) with 3.1% being from the Reserve classification. The most common infectious conditions were pneumonia (21.3%; 148/1013) and clinical sepsis (16.0%; 111/1013). Parenteral administration (75.6%) and prolonged surgical prophylaxis (66.7%; 10/15) were common and concerns. 28% of the paediatric patients had cultures requested for them before antimicrobial treatment (284/1013) however only 38.7% (110/284) of culture results were available in the files. CONCLUSION Overall, antimicrobial prescribing is common among paediatric patients in South Africa. Interventions should be targeted at improving antimicrobial prescribing, including surgical prophylaxis, and encouraging greater use of oral antibiotics.
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Affiliation(s)
- P P Skosana
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa.
| | - N Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa.
| | - B Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.
| | - A Kurdi
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
| | - D Kruger
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa
| | - J C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa; Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.
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Aboderin AO, Adeyemo AT, Olayinka AA, Oginni AS, Adeyemo AT, Oni AA, Olabisi OF, Fayomi OD, Anuforo AC, Egwuenu A, Hamzat O, Fuller W. Antimicrobial use among hospitalized patients: A multi-center, point prevalence survey across public healthcare facilities, Osun State, Nigeria. Germs 2021; 11:523-535. [PMID: 35096669 PMCID: PMC8789356 DOI: 10.18683/germs.2021.1287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 10/21/2023]
Abstract
INTRODUCTION In order to inform sub-national action plan for control of antimicrobial resistance (AMR) and benchmark interventions to improve antibiotic use, it is essential to define situations on antibiotic use using standardized tools. We sought to assess quality of antimicrobial prescription across all government healthcare facilities with capacities for in-patient care in the first of the 36 states in Nigeria as part of ongoing state-wide situation analysis on AMR. METHODS A survey was conducted between 10-27 June 2019 using the WHO methodology for point prevalence survey on antibiotic use in hospitals. Data was collected from hospital administrators and records of hospitalized patients. Data analysis was done using Microsoft Excel 2010 (Redmond Washington). RESULTS Prevalence of antibiotic use amongst all 321 included patients was 76.6% (246/321). Of all indications recorded, the highest was surgical prophylaxis (96/260, 36.9%) for which there were multiple doses beyond 24 hours in almost all cases (91/96, 94.8%). The largest volume of prescribing took place in the surgical wards, and the most common prescriptions were metronidazole (142/564, 25.2%), cefuroxime (104/564, 18.4%), and ceftriaxone (77/564, 13.7%). Overall, 46.3% of the antibiotics used belong to Access group, 53.5% to watch and only 0.2% to Reserve. Treatment in almost all instances 544/563 (96.6%) was empiric. CONCLUSIONS The majority of patients received multiple antibiotics mostly without compliance to guidelines. There was low prescribing of Access antibiotics and excessive use of antibiotics in the Watch group. Antibiotics were used most commonly for surgical prophylaxis but inappropriately. Inappropriate use of antibiotics in this study underscores the crucial need for an action plan incorporating antimicrobial stewardship.
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Affiliation(s)
- Aaron O. Aboderin
- MBChB, MSc, FMCPath, FRCPath, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Adeyemi T. Adeyemo
- MBBS, FMCPath, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Ademola A. Olayinka
- MSc, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, PMB 13, Ile-Ife, Nigeria
| | - Adeniyi S. Oginni
- MBChB, PhD, Osun State Health Insurance Scheme, Ogo-Oluwa, Osogbo, Nigeria
| | - Abolaji T. Adeyemo
- MBBS, FWACP, Department of Medical Microbiology, Ladoke Akintola University of Technology Teaching Hospital, PMB 5000, Osogbo, Nigeria
| | - Abayomi A. Oni
- MBChB, FWACS, Directorate of Medical Services, Hospital Management Board, Abere, Osogbo, Osun State, Nigeria
| | - Olatunde F. Olabisi
- MBChB, FMCPath, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Oluwaseun D. Fayomi
- MBBS, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Anthony C. Anuforo
- MBChB, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Abiodun Egwuenu
- MBBS, MPH, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Omotayo Hamzat
- BPharm MSc, World Health Organization, PMB 2861, Abuja, Nigeria
| | - Walter Fuller
- MD, World Health Organization Regional Office for Africa, P.O. Box 06, Brazzaville, Congo
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Mustafa ZU, Salman M, Yasir M, Godman B, Majeed HA, Kanwal M, Iqbal M, Riaz MB, Hayat K, Hasan SS. Antibiotic consumption among hospitalized neonates and children in Punjab province, Pakistan. Expert Rev Anti Infect Ther 2021; 20:931-939. [PMID: 34591720 DOI: 10.1080/14787210.2021.1986388] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Periodic surveillance of antibiotic consumption in the form of point prevalence studies is a quick and robust methodology to evaluate prescribing trends in hospitals. The current study was undertaken to document antibiotic consumption among neonates and children from hospitals in Pakistan. METHODS This large multicenter study using the World Health Organization standardized methodology and AWaRe (Access, Watch, and Reserve) classification examined antibiotic consumption for suspected bacterial infection among neonates and children admitted hospitals in Punjab, Pakistan. RESULTS A total of 708 beds of children wards of the 16 health facilities were examined. Almost all (97%) hospitalized children were prescribed antibiotics on the day of the assessment with 2.6 antibiotics per patient. The three most common indications were respiratory tract infections (31.58%), sepsis (26.52%), and prophylaxis for medical problems (10.30%). The three most frequently prescribed antibiotics were ceftriaxone (24.2%), amikacin (23.2%), and ampicillin (16.7%). Almost half of the antibiotics were prescribed from the 'Access' (49.5%) and 'Watch' (45.5%) categories under the AWaRe classification. However, no antimicrobial was prescribed from the 'Reserved' category. CONCLUSIONS Our findings indicate that empirical antimicrobials use among hospitalized children is highly prevalent in Pakistan. The utilization of 'Watch' category of antimicrobials is frequent, stressing immediate action.
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Affiliation(s)
- Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital, Pakpattan, Pakistan
| | - Muhammad Salman
- Department of Pharmacy, The University of the Lahore, Lahore, Pakistan
| | - Muhammad Yasir
- Department of Medicine, Quaid E Azam Medical College Bahawalpur, Bahawalpur, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hafiz Abdul Majeed
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital, Pakpattan, Pakistan
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Okara South City, Okara, Pakistan
| | - Maryam Iqbal
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Hafiz Abad, Hafiz Abad, Pakistan
| | - Muhammad Bilal Riaz
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Chakwal, Chakwal, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Easy Access to Antibiotics; Spread of Antimicrobial Resistance and Implementation of One Health Approach in India. J Epidemiol Glob Health 2021; 11:444-452. [PMID: 34734384 PMCID: PMC8477994 DOI: 10.1007/s44197-021-00008-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/14/2021] [Indexed: 11/01/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public health concern because of its fast spread. India, one of the world's top consumer of antibiotics and second most populated country has its unique constraints of social, cultural and economic strata. The continual self-medication, use of antibiotics for the growth promotion in animals, and accumulation of residual antibiotics in the environment challenge the implementation of AMR containment policy. Hence, the present review attempts to delineate the influence of antibiotics abuse on the human, animal and environmental health under the realm of one health. It was based on the literature search using public databases to highlight the rapid surge in the burden of AMR in India affecting various sectors and/or ecosystems in India. It was found that the irrational and overuse of antibiotics in different sectors have led to the emergence of extended antimicrobial resistance wherein the environment acts as a reservoir of antibiotic resistance genes (ARGs); completing the cycle of contamination and recontamination. There are efforts by government policy makers to reduce the burden of AMR in the country to reduce the health risks, through the One Health approach. Parallel efforts in educating healthcare professionals, strict legislation for pharmacies and pharmaceutical companies should be prioritize. At the same time surveillance of newly emerged AMR pathogens, prioritising research focusing on AMR, and awareness camps or programs among the local population is critical while addressing the consequences of spared of AMR in India.
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Panditrao AM, Shafiq N, Chatterjee S, Pathak A, Trivedi N, Sadasivam B, Kshirsagar N, Kaul R, Biswal M, Kakkar A, Malhotra S, Arora P, Talati S, Dhaliwal N, Hazra A, Jhaj R, Najmi A, Pandey N, Chakraverty R, Pathan S, Chauhan J, Mathur A. A multicentre point prevalence survey (PPS) of antimicrobial use amongst admitted patients in tertiary care centres in India. J Antimicrob Chemother 2021; 76:1094-1101. [PMID: 34244744 DOI: 10.1093/jac/dkaa533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Data from point prevalence surveys (PPSs) in India are scarce. Conducting PPSs is especially challenging in the absence of electronic medical records, a lack of dedicated resources and a high patient load in resource-poor settings. This multicentre survey was conducted to provide background data for planning and strengthening antimicrobial stewardship programmes across the country. METHODS This inpatient PPS was conducted over 2 weeks in May 2019 simultaneously across five study centres in India. Data about patient characteristics, indications for antimicrobials use and details of each antimicrobial prescribed including supportive investigation reports were collected in predesigned forms. RESULTS A total of 3473 admitted patients in wards and ICUs were covered across five study centres. Of these, 1747 (50.3%) patients were on antimicrobials, with 46.9% patients being on two or more antimicrobials. Out of the total antimicrobials prescribed, 40.2% of the antimicrobials were prescribed for community-acquired infection requiring hospitalization followed by surgical prophylaxis (32.6%). Third-generation cephalosporins and drugs from the 'Watch' category were prescribed most commonly. Only 22.8% of the antimicrobials were based on microbiology reports. CONCLUSIONS The survey demonstrated a high use of antimicrobials in admitted patients with a considerable proportion of drugs from the 'Watch' category. The targets for interventions that emerged from the survey were: improving surgical prophylaxis, decreasing double anaerobic cover, initiating culture of sending cultures and de-escalation with targeted therapy.
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Affiliation(s)
- Aditi M Panditrao
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suparna Chatterjee
- Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Ashish Pathak
- Ruxmaniben Deepchand Gardi Medical College (RDGMC), Ujjain, Madhya Pradesh, India
| | - Niyati Trivedi
- Government Medical College and Hospital (GMC), Vadodara, Gujarat, India
| | | | | | - Rajni Kaul
- Indian Council of Medical Research, New Delhi, India
| | - Manisha Biswal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Kakkar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Arora
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shweta Talati
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Dhaliwal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Avijit Hazra
- Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Ratinder Jhaj
- All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Ahmad Najmi
- Government Medical College and Hospital (GMC), Vadodara, Gujarat, India
| | - Navin Pandey
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Raja Chakraverty
- Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Saman Pathan
- All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Janki Chauhan
- Government Medical College and Hospital (GMC), Vadodara, Gujarat, India
| | - Aditya Mathur
- Ruxmaniben Deepchand Gardi Medical College (RDGMC), Ujjain, Madhya Pradesh, India
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Opatowski L, Opatowski M, Vong S, Temime L. A One-Health Quantitative Model to Assess the Risk of Antibiotic Resistance Acquisition in Asian Populations: Impact of Exposure Through Food, Water, Livestock and Humans. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2021; 41:1427-1446. [PMID: 33128307 DOI: 10.1111/risa.13618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
Antimicrobial resistance (AMR) has become a major threat worldwide, especially in countries with inadequate sanitation and low antibiotic regulation. However, adequately prioritizing AMR interventions in such settings requires a quantification of the relative impacts of environmental, animal, and human sources in a One-Health perspective. Here, we propose a stochastic quantitative risk assessment model for the different components at interplay in AMR selection and spread. The model computes the incidence of AMR colonization in humans from five different sources: water or food consumption, contacts with livestock, and interhuman contacts in hospitals or the community, and combines these incidences into a per-year acquisition risk. Using data from the literature and Monte-Carlo simulations, we apply the model to hypothetical Asian-like settings, focusing on resistant bacteria that may cause infections in humans. In both scenarios A, illustrative of low-income countries, and B, illustrative of high-income countries, the overall individual risk of becoming colonized with resistant bacteria at least once per year is high. However, the average predicted incidence of colonization was lower in scenario B at 0.82 (CrI [0.13, 5.1]) acquisitions/person/year, versus 1.69 (CrI [0.66, 11.13]) acquisitions/person/year for scenario A. A high percentage of population with no access to improved water on premises and a high percentage of population involved in husbandry are shown to strongly increase the AMR acquisition risk. The One-Health AMR risk assessment framework we developed may prove useful to policymakers throughout Asia, as it can easily be parameterized to realistically reproduce conditions in a given country, provided data are available.
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Affiliation(s)
- Lulla Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Marion Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France
- UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Sirenda Vong
- WHO Health Emergencies Department, World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
- PACRI unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
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McMullan BJ, Hall L, James R, Mostaghim M, Jones CA, Konecny P, Blyth CC, Thursky KA. Antibiotic appropriateness and guideline adherence in hospitalized children: results of a nationwide study. J Antimicrob Chemother 2021; 75:738-746. [PMID: 31697335 DOI: 10.1093/jac/dkz474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/01/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Information on the nature and appropriateness of antibiotic prescribing for children in hospitals is important, but scarce. OBJECTIVES To analyse antimicrobial prescribing and appropriateness, and guideline adherence, in hospitalized children across Australia. PATIENTS AND METHODS We analysed data from the National Antimicrobial Prescribing Survey (NAPS) from 2014 to 2017. Surveys were performed in hospital facilities of all types (public and private; major city, regional and remote). Participants were admitted children <18 years old. Risk factors associated with inappropriate prescribing were explored using logistic regression models. RESULTS Among 6219 prescriptions for 3715 children in 253 facilities, 19.6% of prescriptions were deemed inappropriate. Risk factors for inappropriate prescribing included non-tertiary paediatric hospital admission [OR 1.37 (95% CI 1.20-1.55)] and non-major city hospital location [OR 1.52 (95% CI 1.30-1.77)]. Prescriptions for neonates, immunocompromised children and those admitted to an ICU were less frequently inappropriate. If a restricted antimicrobial was prescribed and not approved, the prescription was more likely to be inappropriate [OR 12.9 (95% CI 8.4-19.8)]. Surgical prophylaxis was inappropriate in 59% of prescriptions. CONCLUSIONS Inappropriate antimicrobial prescribing in children was linked to specific risk factors identified here, presenting opportunities for targeted interventions to improve prescribing. This information, using a NAPS dataset, allows for analysis of antimicrobial prescribing among different groups of hospitalized children. Further exploration of barriers to appropriate prescribing and facilitators of best practice in this population is recommended.
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Affiliation(s)
- Brendan J McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mona Mostaghim
- Department of Pharmacy, Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Cheryl A Jones
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Pamela Konecny
- Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, Sydney, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Australia
| | - Karin A Thursky
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
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21
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Ravi G, Chikara G, Bandyopadhyay A, Handu S. A prospective study to evaluate antimicrobial prescribing pattern among admitted patients in hilly Himalayan region of northern India. J Family Med Prim Care 2021; 10:1607-1613. [PMID: 34123900 PMCID: PMC8144753 DOI: 10.4103/jfmpc.jfmpc_1230_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aim Global scenario of antimicrobial (AM) utilization depicts 20-50% inappropriateness. Majority of the hospital admissions are due to unwanted effects because of non-judicial usage of these drugs. The present study focuses on utilization pattern of antimicrobials (AMs) in a tertiary care hospital in northern India. Materials and Methods A prospective observational study was conducted over a period of one year in seven departments of a tertiary care hospital in hilly Himalayan region. Aim of the study was to analyze the AM utilization pattern using World Health Organization (WHO) indicators and instruments. Results A total 700 prescriptions were analyzed in the present study. Injectable antibiotics (71%) followed by oral (29%) were most commonly prescribed. Beta lactams (79%) were the most frequently used antibiotic class. Most commonly prescribed AM was Ceftriaxone (30%). Majority of the time AMs were given empirically (44.8%), where most common indication was respiratory infections (42%). Culture and sensitivity tests were done for guiding curative therapy in 34.71% cases. The average duration of patient hospital stay was 8.81 days in the study population. The mean duration of prescribed antimicrobial treatment was 5.12 days. On an average 1.93 AMs were prescribed per patient. AMs were prescribed by International nonproprietary name (INN) in 62.19% of the admissions. The most common AM related adverse drug reaction was gastritis (96%) and skin rash (4%) with Amoxicillin + clavulanic acid being the most common causative agent. Total antimicrobial consumption was 148.24 DDD/100 bed days with Medicine department showing the highest consumption (36.25/100 bed days). Conclusion The present study is the first and largest antimicrobial utilization study in the hilly Himalayan region of northern India. Our study found an urgent need for improvement of prescribing patterns, patient care indicators and strict adherence to standard guidelines.
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Affiliation(s)
- Gandham Ravi
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India
| | - Gaurav Chikara
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India
| | - Arkapal Bandyopadhyay
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India
| | - Shailendra Handu
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, India
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Tribble AC, Lee BR, Flett KB, Handy LK, Gerber JS, Hersh AL, Kronman MP, Terrill CM, Sharland M, Newland JG. Appropriateness of Antibiotic Prescribing in United States Children's Hospitals: A National Point Prevalence Survey. Clin Infect Dis 2021; 71:e226-e234. [PMID: 31942952 DOI: 10.1093/cid/ciaa036] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies estimate that 30%-50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children is needed to guide pediatric antimicrobial stewardship. METHODS Cross-sectional analysis of antibiotic prescribing at 32 children's hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 quarters (quarter 3 2016-quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification. RESULTS Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥ 1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥ 1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug-drug mismatch (27.7%), surgical prophylaxis > 24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders. CONCLUSIONS Across 32 children's hospitals, approximately 1 in 3 hospitalized children are receiving 1 or more antibiotics at any given time. One-quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.
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Affiliation(s)
- Alison C Tribble
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian R Lee
- Department of Pediatrics, Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Kelly B Flett
- Novant Health Eastover Pediatrics, Charlotte, North Carolina, USA
| | - Lori K Handy
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Matthew P Kronman
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Cindy M Terrill
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
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Wang CN, Tong J, Yi B, Huttner BD, Cheng Y, Li S, Wan C, Zhu Q, Zhou Q, Zhao S, Zhuo Z, Wang D, Jia C, Shan QW, Zhao Y, Lan C, Zhao D, Zhou Y, Liu J, Zhu C, Zhu Y, Li R, Wu X, Qi Z, Wang C, Gao H, Ye W, Zhang L, Xu X, Hu H, Yang P, Magrini N, Zeng M. Antibiotic Use Among Hospitalized Children and Neonates in China: Results From Quarterly Point Prevalence Surveys in 2019. Front Pharmacol 2021; 12:601561. [PMID: 33854430 PMCID: PMC8039455 DOI: 10.3389/fphar.2021.601561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Antimicrobial resistance is a significant clinical problem in pediatric practice in China. Surveillance of antibiotic use is one of the cornerstones to assess the quality of antibiotic use and plan and assess the impact of antibiotic stewardship interventions. Methods: We carried out quarterly point prevalence surveys referring to WHO Methodology of Point Prevalence Survey in 16 Chinese general and children's hospitals in 2019 to assess antibiotic use in pediatric inpatients based on the WHO AWaRe metrics and to detect potential problem areas. Data were retrieved via the hospital information systems on the second Monday of March, June, September and December. Antibiotic prescribing patterns were analyzed across and within diagnostic conditions and ward types according to WHO AWaRe metrics and Anatomical Therapeutic Chemical (ATC) Classification. Results: A total of 22,327 hospitalized children were sampled, of which 14,757 (66.1%) were prescribed ≥1 antibiotic. Among the 3,936 sampled neonates (≤1 month), 59.2% (n = 2,331) were prescribed ≥1 antibiotic. A high percentage of combination antibiotic therapy was observed in PICUs (78.5%), pediatric medical wards (68.1%) and surgical wards (65.2%). For hospitalized children prescribed ≥1 antibiotic, the most common diagnosis on admission were lower respiratory tract infections (43.2%, n = 6,379). WHO Watch group antibiotics accounted for 70.4% of prescriptions (n = 12,915). The most prescribed antibiotic ATC classes were third-generation cephalosporins (41.9%, n = 7,679), followed by penicillins/β-lactamase inhibitors (16.1%, n = 2,962), macrolides (12.1%, n = 2,214) and carbapenems (7.7%, n = 1,331). Conclusion: Based on these data, overuse of broad-spectrum Watch group antibiotics is common in Chinese pediatric inpatients. Specific interventions in the context of the national antimicrobial stewardship framework should aim to reduce the use of Watch antibiotics and routine surveillance of antibiotic use using WHO AWaRe metrics should be implemented.
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Affiliation(s)
- Chu-ning Wang
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
| | - Jianning Tong
- Department of Pediatric Gastroenterology and Infectious Diseases, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Bin Yi
- Department of Neonatology, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Benedikt D. Huttner
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yibing Cheng
- Department of Emergency, Children's Hospital Affiliated to Zhengzhou University (Henan Children's Hospital), Zhengzhou, China
| | - Shuangjie Li
- Department of Hepatology, Hunan Children’s Hospital, Changsha, China
| | - Chaomin Wan
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
| | - Qingxiong Zhu
- Department of Infectious Diseases, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Qionghua Zhou
- Department of Infectious Diseases, Hainan Women and Children’s Medical Center, Haikou, China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, China
| | - Zhiqiang Zhuo
- Department of Infectious Diseases, Xiamen Children’s Hospital, Xiamen, China
| | - Daobin Wang
- Department of Pediatrics, People’s Hospital of Zhecheng County, Shangqiu, China
| | - Chunmei Jia
- Department of Pediatrics, The Fourth Hospital of Baotou, Baotou, China
| | - Qing-wen Shan
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yun Zhao
- Department of Respiratory Medicine, Chengdu Children Special Hospital, Chengdu, China
| | - Chenfu Lan
- Department of Pediatrics, Lishui Maternal and Child Health Care Hospital, Lishui, China
| | - Dongchi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yibo Zhou
- Department of General Pediatrics, Children’s Hospital Affiliated to Zhengzhou University (Henan Children’s Hospital), Zhengzhou, China
| | - Jing Liu
- Department of Infectious Diseases, Hunan Children's Hospital, Changsha, China
| | - Chunhui Zhu
- Department of Infectious Diseases, Children’s Hospital of Jiangxi Province, Nanchang, China
| | - Yu Zhu
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu, China
| | - Rui Li
- Department of Pediatric Gastroenterology and Infectious Diseases, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Xiaodan Wu
- Department of Infectious Diseases, Hainan Women and Children’s Medical Center, Haikou, China
| | - Zhenghong Qi
- Department of Infectious Diseases, Hangzhou Children’s Hospital, Hangzhou, China
| | - Caihong Wang
- Department of Infectious Diseases, Xiamen Children’s Hospital, Xiamen, China
| | - Huiling Gao
- Department of Pharmacy, The Fourth Hospital of Baotou, Baotou, China
| | - Wenyu Ye
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liling Zhang
- Department of Respiratory Medicine, Chengdu Children Special Hospital, Chengdu, China
| | - Xiaohong Xu
- Department of Digestive Infection, Gansu Provincial Maternity and Child-care Hospital, Lanzhou, China
| | - Hui Hu
- Department of Pediatrics, Lishui Maternal and Child Health Care Hospital, Lishui, China
| | - Pu Yang
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Mei Zeng
- Department of Infectious Diseases, Children’s Hospital of Fudan University, Shanghai, China
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Kruger D, Dlamini NN, Meyer JC, Godman B, Kurdi A, Lennon M, Bennie M, Schellack N. Development of a web-based application to improve data collection of antimicrobial utilization in the public health care system in South Africa. Hosp Pract (1995) 2021; 49:184-193. [PMID: 33566710 PMCID: PMC8315208 DOI: 10.1080/21548331.2021.1889213] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper-based systems. A web-based application (APP) was developed in South Africa to address this, building on a recent point prevalence survey (PPS) using a paper-based system. Consequently, there was a need to test and evaluate the ease of use of a newly developed app and potential time saving versus paper-based methods for PPS. The findings can be used to further refine the APP. Methods The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection, the app was evaluated for functionality on 35 variables and subsequently refined. After data collection, the app was evaluated in terms of its time-saving potential and ease of use. Results 181 patient’s files were surveyed across 13 wards in the hospital, with the antimicrobial usage findings similar to the previous paper-based study in the same hospital. The median age for males was 45.5 years and 42 years for females. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the pediatric medical wards. All the data collectors were confident in using the app after training and found the tool is not complex at all to use. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spent in data collection and analysis is important for timely instigation of quality improvement programs in resource limited settings. Conclusions All data collectors would recommend the app for future PPSs. Several concerns with data entry were identified, which have now been addressed. The app development has been successful and is now being deployed across South Africa as part of a national PPS as well as wider.
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Affiliation(s)
- D Kruger
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Pharmacy, Private Hospital, Pretoria, South Africa
| | - N N Dlamini
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - J C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - B Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - A Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - M Lennon
- Computer and Information Sciences, University of Strathclyde, Glasgow, UK
| | - M Bennie
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - N Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Mohammed ZA, Mukhopadhyay C, Varma M, Kalwaje Eshwara V. Identifying opportunities for antimicrobial stewardship through a point prevalence survey in an Indian tertiary-care teaching hospital. J Glob Antimicrob Resist 2020; 23:315-320. [PMID: 33199265 DOI: 10.1016/j.jgar.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Zabiuddin Ahad Mohammed
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India; Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Muralidhar Varma
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India; Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Vandana Kalwaje Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India.
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Hsia Y, Lee BR, Versporten A, Yang Y, Bielicki J, Jackson C, Newland J, Goossens H, Magrini N, Sharland M. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries. LANCET GLOBAL HEALTH 2020; 7:e861-e871. [PMID: 31200888 DOI: 10.1016/s2214-109x(19)30071-3] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/11/2018] [Accepted: 02/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS.
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Affiliation(s)
- Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK.
| | | | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Yonghong Yang
- Laboratory of Microbiology and Immunology, Beijing Children's Hospital, Capital Medical University, Beijing, China; Department of Internal Medicine, Shenzhen Children's Hospital, Shenzhen, China
| | - Julia Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK; Paediatric Pharmacology and Paediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Charlotte Jackson
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Jason Newland
- Department of Pediatrics, Washington University in St Louis Children's Hospital, St Louis, MO, USA
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, WHO, Geneva, Switzerland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's University of London, London, UK
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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Britto CD, John J, Verghese VP, Pollard AJ. A systematic review of antimicrobial resistance of typhoidal Salmonella in India. Indian J Med Res 2019; 149:151-163. [PMID: 31219079 PMCID: PMC6563740 DOI: 10.4103/ijmr.ijmr_830_18] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background & objectives: The temporal trends in the development of antimicrobial resistance (AMR) among Salmonella Typhi and Salmonella Paratyphi in India have not been systematically reported. We aimed to systematically review the temporal AMR trends (phenotypic and molecular mechanisms) in bacterial isolates from patients with enteric fever over two decades in India. Methods: To identify trends in AMR in India, resistance patterns among 4611 individual S. Typhi isolates and 800 S. Paratyphi A isolates, reported from 1992 to 2017 in 40 publications, were analysed. Molecular resistance determinants were extracted from 22 publications and also reviewed in accordance with the PRISMA guidelines. Articles were sourced using a predefined search strategy from different databases. Results: The analyses suggested that multidrug-resistant (MDR) enteric fever was declining in India and being replaced by fluoroquinolone (FQ) resistance. Mutations in gyrA and parC were key mechanisms responsible for FQ resistance, whereas MDR was largely driven by resistance determinants encoded on mobile genetic elements (plasmids, transposons). Interpretation & conclusions: The results reflect the effect of antimicrobial pressure which has been driving AMR in typhoidal Salmonella in India. Understanding these trends is important in planning future approaches to therapy, which serve as a baseline for assessment of the impact of new typhoid conjugate vaccines against these resistant organisms.
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Affiliation(s)
- Carl D Britto
- Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jacob John
- Department of Community Medicine, Christian Medical College, Vellore, India
| | - Valsan P Verghese
- Department of Paediatrics, Christian Medical College, Vellore, India
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford & NIHR Oxford Biomedical Research Centre, Oxford, UK
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Muloi D, Fèvre EM, Bettridge J, Rono R, Ong'are D, Hassell JM, Karani MK, Muinde P, van Bunnik B, Street A, Chase-Topping M, Pedersen AB, Ward MJ, Woolhouse M. A cross-sectional survey of practices and knowledge among antibiotic retailers in Nairobi, Kenya. J Glob Health 2019; 9:010412. [PMID: 31489183 PMCID: PMC6708591 DOI: 10.7189/jogh.09.020412] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) driven by antibiotic consumption is a growing global health threat. However, data on antimicrobial consumption patterns in low- and middle-income countries (LMICs) is sparse. Here, we investigate the patterns of antibiotic sales in humans and livestock in urban Nairobi, Kenya, and evaluate the level of awareness and common behaviours related to antibiotic use and AMR amongst human and veterinary pharmacists. METHODS A total of 40 human and 19 veterinary drug store pharmacists were interviewed in Nairobi in 2018 using a standard questionnaire. Data recorded included demographic variables, types of antibiotics sold, antibiotic customers, antibiotic prescribing practices and knowledge of antibiotic use and AMR. RESULTS Our study shows that at the retail level, there is a considerable overlap between antibiotic classes (10/15) sold for use in both human and veterinary medicine. Whilst in our study, clinical training significantly influenced knowledge on issues related to antibiotic use and AMR and respondents had a relatively adequate level of knowledge about AMR, several inappropriate prescribing practices were identified. For example, we found that most veterinary and human drug stores (100% and 52% respectively) sold antibiotics without a prescription and noted that customer preference was an important factor when prescribing antibiotics in half of the drug stores. CONCLUSION Although more research is needed to understand the drivers of antibiotic consumption in both human and animal populations, these findings highlight the need for immediate strategies to improve prescribing practices across the pharmacists in Nairobi and by extension other low- and middle-income country settings.
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Affiliation(s)
- Dishon Muloi
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
- International Livestock Research Institute, Nairobi, Kenya
- Contributed equally to this work
| | - Eric M Fèvre
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- International Livestock Research Institute, Nairobi, Kenya
- Contributed equally to this work
| | - Judy Bettridge
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Robert Rono
- International Livestock Research Institute, Nairobi, Kenya
| | - Daniel Ong'are
- International Livestock Research Institute, Nairobi, Kenya
| | - James M Hassell
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- International Livestock Research Institute, Nairobi, Kenya
| | | | - Patrick Muinde
- International Livestock Research Institute, Nairobi, Kenya
| | - Bram van Bunnik
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
| | - Alice Street
- Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Margo Chase-Topping
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Amy B Pedersen
- Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Melissa J Ward
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Mark Woolhouse
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
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Gandra S, Kotwani A. Need to improve availability of "access" group antibiotics and reduce the use of "watch" group antibiotics in India for optimum use of antibiotics to contain antimicrobial resistance. J Pharm Policy Pract 2019; 12:20. [PMID: 31346472 PMCID: PMC6636108 DOI: 10.1186/s40545-019-0182-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/15/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
- Sumanth Gandra
- 1Department of Medicine, Washington University School of Medicine, Saint Louis, MO USA
| | - Anita Kotwani
- 2Department of Pharmacology, V. P. Chest Institute, University of Delhi, Delhi, 110007 India
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Anand Paramadhas BD, Tiroyakgosi C, Mpinda-Joseph P, Morokotso M, Matome M, Sinkala F, Gaolebe M, Malone B, Molosiwa E, Shanmugam MG, Raseatlholo GP, Masilo J, Oyeniran Y, Marumoloa S, Maakelo OG, Katjakae I, Kgatlwane J, Godman B, Massele A. Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications. Expert Rev Anti Infect Ther 2019; 17:535-546. [PMID: 31257952 DOI: 10.1080/14787210.2019.1629288] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.
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Affiliation(s)
| | - Celda Tiroyakgosi
- b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana
| | - Pinkie Mpinda-Joseph
- c Infection Prevention and Control Program , Nyangabgwe Hospital , Francistown , Botswana
| | - Mathudi Morokotso
- b Botswana Essential Drugs Action Program , Ministry of Health and Wellness , Gaborone , Botswana
| | | | - Fatima Sinkala
- e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana
| | - Mavis Gaolebe
- e Department of Pharmacy , Letsholathebe II Memorial Hospital , Maun , Botswana
| | | | - Emmanuel Molosiwa
- g Department of Pharmacy , Mahalapye District Hospital , Mahalapye , Botswana
| | | | | | - Joyce Masilo
- j Department of Pharmacy , Bobonong Primary Hospital , Bobonong , Botswana
| | - Yomi Oyeniran
- k Department of Pharmacy , Goodhope Primary Hospital , Gaborone , Botswana
| | - Stella Marumoloa
- l Department of Pharmacy , Lethlakane Primary Hospital , Letlhakane , Botswana
| | | | - Ishmael Katjakae
- m Department of Pharmacy , Gweta Primary Hospital , Gweta , Botswana
| | - Joyce Kgatlwane
- n School of Pharmacy , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- o Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Huddinge , Sweden.,p Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,q Health Economics Centre , Liverpool University Management School , Liverpool , UK.,r School of Pharmacy , Sefako Makgatho Health Sciences University , Garankuwa , South Africa
| | - Amos Massele
- s Department of Biomedical Sciences, Faculty of Medicine , University of Botswana , Gaborone , Botswana
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Dlamini NN, Meyer JC, Kruger D, Kurdi A, Godman B, Schellack N. Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: a pilot study and implications. Hosp Pract (1995) 2019; 47:88-95. [PMID: 30963821 DOI: 10.1080/21548331.2019.1592880] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES There is currently a lack of data regarding antimicrobial use among public hospitals in South Africa. This is a concern given their growing use and increasing antimicrobial resistance rates in South Africa. Consequently, the objectives of this study were to firstly determine the appropriateness of point prevalence survey (PPS) data collection instruments for performing antimicrobial utilization studies among public sector hospitals in South Africa; secondly, to determine current antimicrobial utilization in a public sector hospital, and thirdly evaluate the prescribing of antimicrobials with those contained within the national Essential Medicines List and Standard Treatment Guidelines (EML/STGs). The findings will be used to guide future activities in South Africa. METHODS A PPS was conducted in Dr George Mukhari Academic Hospital. For each in-patient ward, all patients' files were completely surveyed on a single day. The number of patients who were on antimicrobials served as the numerator and the denominator comprised the total number of patients in the ward. RESULTS 39 wards and 512 patient files were surveyed. The overall prevalence of antimicrobial use was 37.7%, highest in the ICUs. Beta lactamase inhibitors and antimicrobials for tuberculosis were the most prevalent antimicrobials. More than two thirds (83%) of antimicrobial treatment was modified following culture sensitivity test results when requested, and 98% of antimicrobials prescribed were contained within the current EML/STGs. In 10.8% of occasions, antimicrobials appear to have been prescribed other than for treatment, i.e. no systemic infection. There were concerns though with the lack of IV to oral switching. CONCLUSION The PPS method offers a standardized tool that can be used to identify targets for quality improvement. However, there were concerns with the time taken to conduct PPS studies, which is an issue in resource limited settings. This is being addressed alongside concerns with the lack of IV to oral switching.
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Affiliation(s)
- Nokuthula N Dlamini
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Johanna C Meyer
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Danie Kruger
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,b Pharmacy , Private Hospital , Pretoria , South Africa
| | - Amanj Kurdi
- c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,d Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden.,e Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - Natalie Schellack
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
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Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Anandan S, Ramasubramanian V, Swaminathan S, Gopalakrishnan R, Soman R, Abraham OC, Ohri VC, Walia K. Newer β-Lactam/β-Lactamase inhibitor for multidrug-resistant gram-negative infections: Challenges, implications and surveillance strategy for India. Indian J Med Microbiol 2019; 36:334-343. [PMID: 30429384 DOI: 10.4103/ijmm.ijmm_18_326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Antimicrobial resistance (AMR) is a major public health concern across the globe, and it is increasing at an alarming rate. Multiple classes of antimicrobials have been used for the treatment of infectious diseases. Rise in the AMR limits its use and hence the prerequisite for the newer agents to combat drug resistance. Among the infections caused by Gram-negative organisms, beta-lactams are one of the most commonly used agents. However, the presence of diverse beta-lactamases hinders its use for therapy. To overcome these enzymes, beta-lactamase inhibitors are being discovered. The aim of this document is to address the burden of AMR in India and interventions to fight against this battle. This document addresses and summarises the following: The current scenario of AMR in India (antimicrobial susceptibility, resistance mechanisms and molecular epidemiology of common pathogens); contentious issues in the use of beta-lactam/beta-lactamase inhibitor as an carbapenem sparing agent; role of newer beta-lactam/beta-lactamase inhibitor agents with its appropriateness to Indian scenario and; the Indian Council of Medical Research interventions to combat drug resistance in terms of surveillance and infection control as a national response to AMR. This document evidences the need for improved national surveillance system and country-specific newer agents to fight against the AMR.
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Affiliation(s)
- Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Agila Kumari Pragasam
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Shalini Anandan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V Ramasubramanian
- Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India
| | | | - Ram Gopalakrishnan
- Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Rajeev Soman
- Department of Infectious Diseases, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - O C Abraham
- Department of Medicine (Unit -1), Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinod C Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Umeokonkwo CD, Madubueze UC, Onah CK, Okedo-Alex IN, Adeke AS, Versporten A, Goossens H, Igwe-Okomiso D, Okeke K, Azuogu BN, Onoh R. Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship. J Glob Antimicrob Resist 2019; 17:291-295. [PMID: 30668994 DOI: 10.1016/j.jgar.2019.01.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022] Open
Abstract
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.
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Affiliation(s)
- Chukwuma David Umeokonkwo
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria; Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
| | | | - Cosmas Kenan Onah
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Ijeoma N Okedo-Alex
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Azuka Stephen Adeke
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Dorothy Igwe-Okomiso
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Kingsley Okeke
- Department of Community Medicine, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Benedict N Azuogu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
| | - Robinson Onoh
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
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Hsia Y, Sharland M, Jackson C, Wong ICK, Magrini N, Bielicki JA. Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries. THE LANCET. INFECTIOUS DISEASES 2019; 19:67-75. [DOI: 10.1016/s1473-3099(18)30547-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 02/05/2023]
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Koopmans LR, Finlayson H, Whitelaw A, Decloedt EH, Dramowski A. Paediatric antimicrobial use at a South African hospital. Int J Infect Dis 2018; 74:16-23. [PMID: 29935284 DOI: 10.1016/j.ijid.2018.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Data on antimicrobial use among hospitalized children in Africa are very limited due to the absence of electronic prescription tracking. METHODS This study evaluated antimicrobial consumption rates, the antimicrobial spectrum used, and the indications for therapy on a paediatric ward and in the paediatric intensive care unit (PICU) at Tygerberg Hospital, Cape Town, South Africa. Antimicrobial prescription and patient demographic data were collected prospectively from May 10, 2015 to November 11, 2015. For the same period, data on antimicrobials dispensed and costs were extracted from the pharmacy electronic medicine management system. The volume of antimicrobials dispensed (dispensing data) was compared with observed antimicrobial use (prescription data). RESULTS Of the 703 patients admitted, 415/451 (92%) paediatric ward admissions and 233/252 (92%) PICU admissions received ≥1 antimicrobials. On the ward, 89% of prescriptions were for community-acquired infections; 29% of PICU antimicrobials were prescribed for healthcare-associated infections. Ampicillin and third-generation cephalosporins were the most commonly prescribed agents. Antimicrobial costs were 67541 South African Rand (ZAR) (5680 United States Dollars (USD)) on the ward and 210484 ZAR (17702 USD) in the PICU. Ertapenem and meropenem were the single largest contributors to antimicrobial costs on the ward (43%) and PICU (30%), respectively. The volume of antimicrobials dispensed by the pharmacy (dispensing data) differed considerably from observed antimicrobial use (prescription data). CONCLUSIONS High rates of antimicrobial consumption were documented. Community-acquired infections were the main indication for prescription. Although pharmacy dispensing data did not closely approximate observed use, this represents a promising method for antimicrobial usage tracking in the future.
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Affiliation(s)
- L R Koopmans
- Undergraduate Research Elective Programme, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa; Radboud University, Radboud UMC, The Netherlands
| | - H Finlayson
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Whitelaw
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa
| | - E H Decloedt
- Department of Medicine, Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Point prevalence surveys of antimicrobial use among eight neonatal intensive care units in India: 2016. Int J Infect Dis 2018; 71:20-24. [PMID: 29608958 PMCID: PMC5985371 DOI: 10.1016/j.ijid.2018.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 11/23/2022] Open
Abstract
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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