Point Prevalence Survey of Antimicrobial Use in Selected Tertiary Care Hospitals of Pakistan Using WHO Methodology: Results and Inferences
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Settings
2.3. Duration
2.4. Sample Size and Sampling Technique
2.5. Survey Tool and Data Collection
2.6. Inclusion Criteria
- ∘
- Patients in acute tertiary care hospitals registered in GLASS sentinel sites;
- ∘
- Patients hospitalized before or at 08:00 hours on the days of the PPS whether they are receiving antibiotics or not and those patients who have complete medical record;
- ∘
- Data of all patients admitted in acute care settings were included;
- ∘
- Only antibiotics included in list administered by oral, parenteral, rectal, or inhalation routes;
- ∘
- Antibiotic therapy initiated by 08:00 am on survey day.
2.7. Exclusion Criteria
- ∘
- Patients from nursing homes, rehabilitation centers, and psychiatric centers are excluded as per WHO PPS methodology;
- ∘
- Patients admitted after 08:00 am on day of survey, all day care patients;
- ∘
- Inpatients from long-term care wards, Emergency departments, day surgery wards, day care wards (e.g., renal dialysis), outpatient clinic, day surgery/day treatment, outpatient dialysis, discharged patients, and waiting for transportation;
- ∘
- Patients receiving ophthalmologic antibiotics.
2.8. Analysis Plan
3. Results
3.1. Prevalence and Demographics
3.2. Antibiotic Use and Prescription Rate
3.3. Factors Affecting Compliance
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Total | |
---|---|---|
No. | % | |
No. of surveyed patients | 3587 | - |
Mean age of surveyed patients ± SD | 33.4 ± 22.5 | |
Gender | ||
Male | 1828 | 51% |
Female | 1759 | 49% |
Admission specialty | ||
Gynecology | 151 | 4% |
ICU | 152 | 4% |
Medical | 1276 | 36% |
Obstetrics/maternity | 150 | 4% |
Pediatrics and Neonates | 521 | 15% |
Surgery | 1337 | 37% |
Length to stay until day of PPS, days median (IQR) | 7 (0–399) | |
Surgery since admission | 735 | 21% |
Use of invasive devices | ||
Central vascular catheter | 155 | 4% |
Peripheral vascular catheter | 2871 | 80% |
Endotracheal tube | 123 | 3% |
Urinary catheter | 943 | 26% |
Antimicrobials | Antibiotic Use N (%) |
---|---|
Ceftriaxone | 1206 (44.0%) |
Metronidazole | 484 (18.0%) |
Amoxicillin/Clavulanic acid | 302 (11.0%) |
Piperacillin/Tazobactam | 297 (10.9%) |
Amikacin | 257 (9.50%) |
Meropenem | 200 (7.4%) |
Cefoperazone + Sulbactum | 183 (6.77%) |
Vancomycin | 164 (6.0%) |
Cefotaxime | 151 (5.59%) |
Moxifloxacin | 132 (4.88%) |
Factors | Received AM (n = 2701) | Did Not Receive AM (n = 886) | Total | OR | 95% CI | p Value |
---|---|---|---|---|---|---|
No. (%) | No. (%) | No. | ||||
Age | ||||||
Adults (≥18 yrs.) | 1850 (71) | 760 (29) | 2610 | Ref | ||
Pediatrics (<18 yrs.) | 666 (85) | 119 (15) | 751 | 2.3 | 1.86–2.84 | 0.000 |
Neonates (≤1 month) | 185 (96) | 7(4) | 192 | 10.9 | 5.1–23.2 | 0.000 |
Gender | ||||||
Male | 1381 (76) | 447 (24) | 1828 | Ref | ||
Female | 1320 (75) | 439 (25) | 1759 | 0.97 | 0.84–1.13 | 0.726 |
Surgery (n = 3580) | ||||||
No Surgery | 2035 (72) | 810 (28) | 2845 | Ref | ||
Non-NHS (National Healthcare Safety Network) Surgery | 174 (83) | 37 (17) | 211 | 1.87 | 1.3–2.69 | 0.001 |
NHSN Surgery | 488 (93) | 36 (7) | 524 | 5.4 | 3.8–7.6 | 0.000 |
Median Length of stay | 4 | 3 | 1.012 | 1.003–1.022 | 0.012 | |
Admission Specialty | ||||||
Medical | 909 (71) | 367 (29) | 1276 | Ref | ||
Gynecology | 108 (72) | 43 (28) | 151 | 1.01 | 0.7–1.47 | 0.942 |
ICU | 126 (83) | 26 (17) | 152 | 1.96 | 1.26–3.04 | 0.003 |
OBS and maternity | 120 (80) | 30 (20) | 150 | 1.61 | 1.06–2.45 | 0.025 |
Pediatrics and Neonates | 494 (95) | 27 (5) | 521 | 7.39 | 4.92–11.09 | 0.000 |
Surgery | 944 (71) | 393 (29) | 1337 | 0.97 | 0.82–1.15 | 0.722 |
Invasive procedures | ||||||
Central vascular catheter (n = 155) | 146 (94) | 9 (6) | 155 | 5.6 | 2.83–10.96 | 0.000 |
Peripheral vascular catheter (n = 2871) | 2403 (84) | 468 (16) | 2871 | 7.2 | 6.02–8.61 | 0.000 |
Endotracheal tube (n = 123) | 117 (95) | 6 (5) | 123 | 6.64 | 2.9–15.14 | 0.000 |
Urinary catheter (n = 943) | 830 (88) | 113 (12) | 943 | 3.03 | 2.45–3.76 | 0.000 |
Hospital size | ||||||
Less than 500 | 456 (74) | 160 (26) | 616 | Ref | ||
From 500 to 1000 beds | 738 (82) | 167 (18) | 905 | 1.55 | 1.21–1.98 | 0.000 |
More than 1000 beds | 1507 (73) | 559 (27) | 2066 | 0.95 | 0.77–1.16 | 0.594 |
Hospital Type | ||||||
Government | 2354 (77) | 719 (23) | 3073 | Ref | ||
Private | 347 (68) | 167 (32) | 514 | 0.63 | 0.52–0.78 | 0.000 |
Referred from other hospital (n = 191) | 173 (91) | 18 (9) | 191 | 3.3 | 2.02–5.4 | 0.000 |
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Ambreen, S.; Safdar, N.; Ikram, A.; Baig, M.Z.I.; Farooq, A.; Amir, A.; Saeed, A.; Sabih, F.; Ahsan, Q.; Zafar, A.; et al. Point Prevalence Survey of Antimicrobial Use in Selected Tertiary Care Hospitals of Pakistan Using WHO Methodology: Results and Inferences. Medicina 2023, 59, 1102. https://doi.org/10.3390/medicina59061102
Ambreen S, Safdar N, Ikram A, Baig MZI, Farooq A, Amir A, Saeed A, Sabih F, Ahsan Q, Zafar A, et al. Point Prevalence Survey of Antimicrobial Use in Selected Tertiary Care Hospitals of Pakistan Using WHO Methodology: Results and Inferences. Medicina. 2023; 59(6):1102. https://doi.org/10.3390/medicina59061102
Chicago/Turabian StyleAmbreen, Saadia, Numrah Safdar, Aamer Ikram, Mirza Zeeshan Iqbal Baig, Ayesha Farooq, Afreenish Amir, Asim Saeed, Farah Sabih, Qadeer Ahsan, Alia Zafar, and et al. 2023. "Point Prevalence Survey of Antimicrobial Use in Selected Tertiary Care Hospitals of Pakistan Using WHO Methodology: Results and Inferences" Medicina 59, no. 6: 1102. https://doi.org/10.3390/medicina59061102