A national, multicentre web-based point prevalence survey of antimicrobial use and quality indices among hospitalised paediatric patients across South Africa

ObjectiveTo delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes.DesignCross-sectional analytical study.SettingSix referral hospitals in Tanzania.ParticipantsPatients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected.Outcome measuresWe analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics.ResultsApproximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results.ConclusionsEmpirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.

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A Multicentre Point Prevalence Survey of Hospital Antimicrobial Prescribing and Quality Indices in the Kurdistan Region Government of Northern Iraq: The Need for Urgent Action

SSRN Electronic Journal ◽

10.2139/ssrn.3633152 ◽

2020 ◽

Author(s):

Amanj Kurdi ◽

Awat Jamal Hassan ◽

Kirmanj Baker ◽

R Andrew Seaton ◽

Zhian S. Ramzi ◽

...

Keyword(s):

Point Prevalence ◽

Kurdistan Region ◽

Quality Indices ◽

Prevalence Survey ◽

Northern Iraq ◽

Antimicrobial Prescribing ◽

Point Prevalence Survey ◽

Urgent Action

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Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications (Preprint)

10.2196/preprints.16143 ◽

2019 ◽

Author(s):

Natalie Schellack ◽

Danie Kruger ◽

Nokuthula N Dlamini ◽

Johanna C Meyer ◽

Brian Godman ◽

...

Keyword(s):

South Africa ◽

Data Collection ◽

Resource Constraints ◽

Data Entry ◽

Ease Of Use ◽

Point Prevalence ◽

Public Health Care ◽

Time Saving ◽

Prevalence Survey ◽

Web Based

BACKGROUND 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 pilot point prevalence survey (PPS) using a paper-based system. OBJECTIVE The study aim was to test and refine the develop app as well as to evaluate its ease of use and potential time saving versus paper based methods. METHODS The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection phase, the app was evaluated for functionality on all 35 variables and subsequently refined. After the 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 findings similar to the paper-based study. The median age for males was 45.5 years and the median age for females was 42 years. 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 paediatric medical wards. All the data collectors were confident in using the app after training and found the tool not complex at all. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spending is important for instigating quality improvement programmes in resource limited settings. CONCLUSIONS All data collectors would recommend the app for future PPS surveys. Several concerns with data entry were identified, which have now been addressed in both the refined app as well as in future training. The app development has been successful and is now being deployed across South Africa as part of a national PPS.

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Point Prevalence Survey of Antimicrobial Prescription Patterns in a Pediatric Tertiary-Care Unit in Thailand 2019

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.09.12724 ◽

2021 ◽

Vol 104 (9) ◽

pp. 1476-1482

Keyword(s):

Antimicrobial Stewardship ◽

Point Prevalence ◽

Audit And Feedback ◽

Antimicrobial Use ◽

Prospective Audit ◽

Prevalence Survey ◽

Prescription Patterns ◽

Point Prevalence Survey ◽

Stewardship Program ◽

Prospective Audit And Feedback

Background: Surveillance data is an essential part of antimicrobial stewardship programs (ASP). Objective: To describe and compare prescription patterns of antibiotics after a 3-years implementation of an ASP using prospective audit and feedback. Materials and Methods: The authors conducted a point prevalence survey (PPS) of antibiotic prescriptions at a 200-bed pediatric unit at King Chulalongkorn Memorial Hospital. A standardized study protocol from the Global Antimicrobial Resistance, Prescribing, and the Efficacy in Neonates and Children (GARPEC) project was used. The authors reviewed medical charts of hospitalized children of less than 18 years of age, using a point prevalence method on the 15 of February, May, August, and November 2019. Endpoints measures included rate of antimicrobial prescriptions and type of antimicrobial use, stratified by neonatal and pediatric ward types. Rate of antimicrobial prescriptions will be compared with historical data form PPS in the same institute collected in 2016. Results: In 2019, the medical records of 269 neonates and 409 children hospitalized were reviewed. The proportion of children receiving antibiotics in neonatal units overall was 18.6% (95% CI 14.1 to 23.8), of which ampicillin or gentamicin (52.0%) was the most common regimen. Rate of antibiotic prescriptions in general pediatric wards was 46.5%, with third generation cephalosporins being the most used antibiotics. Prescription rate in the oncology ward was 52.9% with antipseudomonal agents or meropenem being the most prescribed antibiotics. Prescription rates in the pediatric intensive care unit (PICU) was 88.9%, with meropenem being the most used antibiotic. Compared to a previous PPS study in 2016, prevalence of antimicrobial use was higher in general pediatric wards at 46.5% versus 37.2% (p=0.02) and PICU at 88.9% versus 67.7% (p=0.007). Conclusion: The prevalence rates of antimicrobial use in pediatric wards increased despite implementation of a prospective audit and feedback antibiotic stewardship program. Other measures are needed to reduce the unnecessary prescriptions. Keywords: Antimicrobial; Antimicrobial stewardship program; Pediatric; Point prevalence survey

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