Title : Point prevalence survey of antimicrobial use in a tertiary training hospital in Zamboanga City, Philippines, 2022
Background: The increasing prevalence of infections due to Antimicrobial Resistance (AMR) constitutes a serious threat to healthcare systems. This study investigated the trends and compliance to antimicrobial prescribing to identify potential areas for quality improvement.
Methods: The antimicrobial use point pevalence survey (APPS) in August 2022 at the Zamboanga City Medical Center (ZCMC), a 400-bed tertiary training institution. The survey included all inpatients receiving antimicrobial on the day of the APPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment, quality indicators, and prevalence of hospital acquired infection (HAI). A web-based application was utilized for data entry, validation and reporting designed for global PPS.
Results: We surveyed a total of 348 inpatients (225 adults and 123 children and neonates). The overall antimicrobial prevalence in the adult wards was 52% and 41.5% in the pediatric and neonatal wards. Betalactam,
mostly cephalosporin (57%) was the most commonly used antibiotic overall. Cefuroxime was the most prescribed antibiotic in the adult (61%) and pediatric medical wards (50%). In surgical pediatric ward, however, fluoroquinolone (27.3%) predominated while aminoglycoside was the most frequently used in the pediatric and neonatal ICU. The most common diagnosis treated with therapeutic antimicrobials were pneumonia (24.1%) and sepsis (17.2%). Community-acquired infections (CAI) and HAI were equally distributed (50%) and were empirically treated by >90%. The hospital-wide prevalence of HAI was 10.3%. Prophylactic antimicrobial use was 35.5% for medical and 64.5% for surgical indications. Surgical prophylactic drug consisted of second-generation cephalosporin (58.8%) which mostly (90%) exceeded 24 hours in use. Antibiotic quality indicators included reasons for antibiotic use being documented in 57.2%, compliance to guidelines (30.9%), and stop order / review date documented in 66.3% of patient’s charts.
Conclusion: Antibiotic prescribing practices in our hospital still warrants further reinforcement as to compliance to rational antibiotic use and to local guidelines, and improvement in surgical prophylaxis prescribing practices.
Key words: Antimicrobial use point prevalence survey, Antimicrobial stewardship, antimicrobial
Audience take away:
- This study will be useful for those practicing in the field of antimicrobial stewardship program in the hospital. It provides information on the trends, practices and compliance to antibiotic prescribing to identify potential areas for quality improvement.
- This study will highlight the need to improve and enhance policies in terms of compliance to prescribing
- rational antibiotic use by developing and updating comprehensive local evidence-based guidelines
- This study provides baseline data that addresses the. growing antimicrobial resistance worldwide.