Point prevalence survey of antibiotics usage in a tertiary care public sector hospital employing WHO methodology.

Authors

  • Sana Tahir Virk Pakistan Institute of Medical Sciences, Islamabad Pakistan
  • Nasim Akhtar Pakistan Institute of Medical Sciences, Islamabad Pakistan
  • Kazim Abbas Virk Hazrat Bari Imam Sarkar Medical and Dental College, Islamabad Pakistan
  • Abeer Zafar Pakistan Institute of Medical Sciences, Islamabad Pakistan
  • Zawwar Zia Pakistan Institute of Medical Sciences, Islamabad Pakistan
  • Wajeh Haider Pakistan Institute of Medical Sciences, Islamabad Pakistan

DOI:

https://doi.org/10.61529/idjp.v33i4.334

Abstract

Background: Antimicrobial resistance (AMR) kills 7 million people annually. WHO recognized AMR as a global threat in 2017 and launched the Point Prevalence Survey (PPS) methodology in 2018. The situation in Pakistan is even worse with an overall prevalence of antibiotic usage of 75 per 100 population.

Material and Methods: This cross-sectional survey was conducted on a single day, 25th May 2024, at the Pakistan Institution of Medical Sciences (PIMS), with a sample size of 271 of 822 eligible patients. The PPS team collected the data using a questionnaire based on the WHO PPS methodology. All acute care and ward patients hospitalized at or before 8:00 A.m. were included.

Results: A total of 271 patients were included in the survey, 110 (40.60%) were females, and 161 (59.40%) were males. The patients aged> 2 months were 248 (91.50%) and < 2 months were 23 (8.5%). The prevalence of antibiotic use in PIMS was 210 (77.6%). The culture sample sent before the first dose of antibiotic was only in 57 (27.1%) patients. The largest indication was community-acquired infections 40 (55.56%). Blood was the most common form of sample sent 45 (47.36%). The culture positivity rate was 21.05%. Klebsiella Pneumoniae was the most detected organism at 25% followed by Pseudomonas aeruginosa at 15%. The target antibiotic prescriptions were only 13.3%. Ninety percent of the antibiotics were given via parenteral route. Ceftriaxone was the most popular antibiotic used 62(20%).

Conclusion: Antibiotics are widely used in our hospital, with the majority being empirical. Most antibiotics are used to treat community-acquired illnesses. Patients whose cultures were sent before their initial antibiotic treatment make up a minor proportion.

Keywords: Community-acquired infections, Indication, Culture, Antibiotic consumption, Point prevalence survey, MDROs

References

Ambreen S, Safdar N, Ikram A, Baig MZI, Farooq A, Amir A, et al. Point prevalence survey of antimicrobial use in selected tertiary care hospitals of Pakistan using WHO methodology: Results and inferences. Medicina (Kaunas). 2023; 59(6): 1102. DOI: https://doi.org/10.3390/medicina59061102

Shaikh Q, Sarfaraz S, Rahim A, Hussain A, Behram S, Kazi AS, et al. WHO point prevalence survey to describe the use of antimicrobials at a tertiary care center in Pakistan: A situation analysis for establishing an antimicrobial stewardship program. Antibiotics (Basel). 20221104th ed. 2022; 11(11): 1555. DOI: https://doi.org/10.3390/antibiotics11111555

Arif S, Sadeeqa S, Saleem Z. Patterns of antimicrobial use in hospitalized children: A repeated point prevalence survey from Pakistan. J Pediatric Infect Dis Soc. 2021; 10(10): 970–4. DOI: https://doi.org/10.1093/jpids/piab026

WHO methodology for point prevalence survey on antibiotic use in hospitals [Internet]. Geneva: World Health Organization; 2018. Available from: https://iris.who.int/

Pauwels I, Versporten A, Vermeulen H, Vlieghe E, Goossens H. Assessing the impact of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) on hospital antimicrobial stewardship programs: Results of a worldwide survey. Antimicrob Resist Infect Control. 2021; 10(1): 138. DOI: https://doi.org/10.1186/s13756-021-01010-w

Sheikh S, Vishwas G, Aggarwal M, Bhattacharya S, Kumari P, Parashar L, et al. Antibiotic point prevalence survey at a tertiary healthcare hospital in India: Identifying strategies to improve the antibiotic stewardship program immediately after a COVID-19 wave. Infect Prev Pract. 2022; 4(4): 100253. DOI: https://doi.org/10.1016/j.infpip.2022.100253

Saleem Z, Haseeb A, Godman B, Batool N, Altaf U, Ahsan U, et al. Point prevalence survey of antimicrobial use during the COVID-19 pandemic among different hospitals in Pakistan: Findings and implications. Antibiotics (Basel). 2022;12(1): 70. DOI: https://doi.org/10.3390/antibiotics12010070

Saleem Z, Hassali MA, Versporten A, Godman B, Hashmi FK, Goossens H, et al. A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: Findings and implications. Expert Rev Anti Infect Ther. 2019; 17(4): 285–93. DOI: https://doi.org/10.1080/14787210.2019.1581063

Soltani J, Behzadi S, Pauwels I, Goossens H, Versporten A. Global-PPS targets for antimicrobial stewardship in paediatric patients at hospitals in Sanandaj, Western Iran, compared with Southeast Asian and European hospitals. J Glob Antimicrob Resist. 2024; 36: 473–81. DOI: https://doi.org/10.1016/j.jgar.2024.01.011

Saleem Z, Saeed H, Hassali MA, Godman B, Asif U, Yousaf M, et al. Pattern of inappropriate antibiotic use among hospitalized patients in Pakistan: A longitudinal surveillance and implications. Antimicrob Resist Infect Control. 2019; 8(1): 188. DOI: https://doi.org/10.1186/s13756-019-0649-5

Arif S, Sadeeqa S, Saleem Z. Patterns of antimicrobial use in Hospitalized Children: A repeated point prevalence survey from Pakistan. J Pediatric Infect Dis Soc. 2021; 10(10): 970-4. DOI: https://doi.org/10.1093/jpids/piab026

Anugulruengkitt S, Charoenpong L, Kulthanmanusorn A, Thienthong V, Usayaporn S, Kaewkhankhaeng W, et al. Point prevalence survey of antibiotic use among hospitalized patients across 41 hospitals in Thailand. JAC Antimicrob Resist. 2023; 5(1): dlac140. DOI: https://doi.org/10.1093/jacamr/dlac140

Fentie AM, Degefaw Y, Asfaw G, Shewarega W, Woldearegay M, Abebe E, et al. Multicentre point-prevalence survey of antibiotic use and healthcare-associated infections in Ethiopian hospitals. BMJ Open. 2022; 12: 54541.

DOI: https://doi.org/10.1136/bmjopen-2021-054541

Veerapa-Mangroo LP, Rasamoelina-Andriamanivo H, Issack MI, Cardinale E. Point prevalence survey on antibiotic use in the hospitals of Mauritius. Frontiers in Antibiotics. 2023; 1: 1045081. DOI: https://doi.org/10.3389/frabi.2022.1045081

D'Arcy N, Ashiru-Oredope D, Olaoye O, Afriyie D, Akello Z, Ankrah D, et al. Antibiotic prescribing patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented. Japheth Awuletey Opintan. 2021; 10(9):1122 2021; 14. DOI: https://doi.org/10.3390/antibiotics10091122

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. 2022; 54(9): 698–701.

DOI: https://doi.org/10.1080/23744235.2022.2064544

Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V, et al. Variations in antibiotic use across India: multi-centre study through Global Point Prevalence survey. J Hosp Infect. 2019; 103 (3): 280-3. DOI: https://doi.org/10.1016/j.jhin.2019.05.014

German GJ, Frenette C, Caissy JA, Grant J, Lefebvre MA, Mertz D, et al. The 2018 global point prevalence survey of antimicrobial consumption and resistance in 47 Canadian hospitals: A cross-sectional survey. CMAJ Open. 2021; 9 (4); E1242-51. DOI: https://doi.org/10.9778/cmajo.20200274

Zumaya-Estrada FA, Alpuche-Aranda CM, Saturno-Hernandez PJ. The WHO methodology for point prevalence surveys on antibiotics use in hospitals should be improved: Lessons from pilot studies in four Mexican hospitals. Int J Infect Dis. 2021; 108: 13-7. DOI: https://doi.org/10.1016/j.ijid.2021.04.079

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Published

2024-12-31

How to Cite

Tahir Virk, S., Akhtar, N., Virk, K. A., Zafar, A., Zia, Z., & Haider, W. (2024). Point prevalence survey of antibiotics usage in a tertiary care public sector hospital employing WHO methodology. Infectious Diseases Journal of Pakistan, 33(4), 186–194. https://doi.org/10.61529/idjp.v33i4.334