A Multicenter Point-Prevalence Survey of Antibiotic Use in Haiti, June–August 2019: Findings and Implications

Background: Inappropriate use of antibiotics in hospitalized settings contributes to the selection and emergence of antimicrobial-resistant pathogens. This trend is particularly challenging in resource-constrained settings where the high burden of infectious diseases, combined with suboptimal infection prevention and control measures, are further complicated by limited access to reliable microbiological services to inform antimicrobial prescription at the patient level. In this study, we describe the use of antibiotics in selected Haitian hospitals; we aimed to create a baseline to inform antimicrobial stewardship interventions. Methods: WHO/PAHO Hospital Antibiotic Use Point Prevalence Survey (HAMU-PPS) were conducted in 6 acute-care Haitian hospitals: La-Paix and Hospital-Albert (June 2019) and Hospital-Universitaire-Justinien, Hospital-Bienfaisance-de-Pignon, Hospital-Sacre-Coeur-de-Milot, and Hospital Immaculee-Conception-des-Cayes (July-August 2019) in 6 different cities. Trained data collectors completed electronic forms using REDCap software including data related to antibiotic use, indications, and utilization of laboratory services from medical records of all inpatients meeting study inclusion criteria. Analyses were done using Microsoft Excel software (v2016). Results: In total, 510 inpatients records were surveyed. Patients ages ranged from 0 to 92, with median age of 27 years (IQR, 4–47); 269 were women (57.7%) and 239 were men (46.9%). The prevalence of antibiotic use was 73% (95% CI, 68.2%–81.8 %); this prevalence was 74.5% among men (178 of 239) and 70.6% among women (190 of 269). The highest antibiotic use was observed among children aged <1 year (98 of 108, 90.7%). Of the patients on antibiotics, 63% were treated with >1 antibiotic. In addition, 384 indications for antibiotic prescription were reported. Of the indications for antibiotics therapy, 49.7% (191 of 384) were for treatment, and 49% (188 of 384) were for prophylaxis. Of the treatments, 92% were empiric with 6% reported as targeted. Only 13% (50 of 370) of the patient records indicated that samples were taken for microbiological identification. Of those, 9 had results for culture, and 1 had results for drug susceptibility. The most commonly reported antibiotic was ceftriaxone (n = 110, 23%) followed by ampicillin (n = 153, 21.4%) and metronidazole (n = 135, 20%). Conclusions: This study shows high use of antibiotics among hospitalized patients in Haitian hospitals, especially in children aged <1 year. Almost all the antibiotics were prescribed as either empiric or prophylaxis therapy, with very few microbiology samples collected. These results suggest limited laboratory corroboration across hospitals to inform antibiotic use. Implementation of antimicrobial stewardship interventions is recommended to optimize antibiotic therapy and to mitigate antimicrobial resistance in hospital care settings, but adaptation of the methodology should be done in settings with limited laboratory capacity.Funding: NoneDisclosures: None

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Point prevalence survey of healthcare-associated infections and antimicrobial use in Kosovo hospitals

Infectious Disease Reports ◽

10.4081/idr.2019.7975 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Lul Raka ◽

Gazmend Spahija ◽

Agreta Gashi-Gecaj ◽

Astrit Hamza ◽

Edita Haxhiu ◽

...

Keyword(s):

Prevalence Rate ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

Infection Prevention And Control ◽

Antimicrobial Use ◽

Surveillance Systems ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Stewardship Program

Health care-associated infections (HAIs) and antimicrobial resistance constitute a major public health challenge. The aim of this study was to assess the prevalence rate of HAIs and antimicrobial use in acute care hospitals in Kosovo. A multicenter study was performed in all hospitals in Kosovo. The standardized protocol for Point Prevalence Survey (PPS) on HAIs and antimicrobial use developed by European Center for Disease Control and Prevention (ECDC) was used for this survey. A total of 915 patients were included in PPS. Countrywide prevalence rate of HAIs was 4.9%. The highest rate was noticed in tertiary care level in University Clinical Centre of Kosovo (UCCK) (7.2%). The most common type of HAI was surgical site infection, representing 35.5% of all reported HAIs. Prevalence of HAIs was highest in surgical departments (46.6%). The median length of stay before onset of HAI was 11 days (range: 3-27 days). Gram negative bacteria were the predominant microorganisms (61% of cases). From all patients, 520 (56.8%) of them were using at least one antibiotic. Ceftriaxone was the most prescribed antibiotic with 40.3%. Antibiotics were administered mainly through parenteral route (93.8%). Empiric treatment was the physician’s choice for prescribing in 87.1%. The main reason for antibiotic treatment was pneumonia (19.8%). Medical prophylaxis was reported in 10% of antibiotic prescriptions. Key recommendations driven by this study are to improve surveillance systems of HAI and antibiotic use, enhance infection prevention and control and establish antimicrobial stewardship program.

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Using longitudinal antibiotic point prevalence survey (PPS) to drive antimicrobial stewardship programmes in a Nigerian tertiary hospital

African Journal of Clinical and Experimental Microbiology ◽

10.4314/ajcem.v22i2.22 ◽

2021 ◽

Vol 22 (2) ◽

pp. 284-289

Author(s):

P. Nwajiobi-Princewill ◽

N. Medugu ◽

M. Gobel ◽

A. Aigbe ◽

A. Versporten ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Institutional Support ◽

Patient Characteristics ◽

Antibiotic Use ◽

Tertiary Hospital ◽

Point Prevalence ◽

Policy Statement ◽

Prevalence Survey ◽

Middle Income ◽

Point Prevalence Survey

Background: Antimicrobial stewardship (AMS) provides a means of tackling antimicrobial resistance (AMR). Unfortunately, in Nigeria, like in some other low-and-middle-income countries (LMICs), AMS practice has been lacklustre due to poor institutional support amongst other factors. Efforts were made to address this situation by engaging with the management of National Hospital Abuja, Nigeria, using antibiotic prescription information obtained through repeated point prevalence survey.Methodology: Two rounds of antibiotic PPS were conducted in 2015 and 2017 using the Global Point Prevalence Survey (G-PPS) format. Data were collected from all inpatients receiving antibiotics on the selected day of study, including patient characteristics, antimicrobial prescription details, laboratory results and information on a set of quality indicators. The data were uploaded to an online G-PPS application hosted at the University of Antwerp in Belgium for validation, analysis and reporting.Results: The PPS data showed that hospital-wide antibiotic use prevalence increased from 58% in 2015 to 61% in 2017. Surgical prophylaxis beyond 24 hours also increased from 88-90% in 2015 to 100% in 2017, and only minority of therapies were supported by laboratory input for diagnosis and monitoring; 22% in 2015 and 5% in 2017.Conclusion: These results were used for evidence-based engagement with the management to formally support AMS activities in the hospital. Positive outcomes were the formal reconstitution and inauguration of AMS committee in 2018 as well as the issuance of a formal policy statement by the hospital in 2020. The ease and free availability of Global PPS methodology makes it ideal in driving antimicrobial stewardship programme (ASP) in LMICs like Nigeria. Keywords: Antibiotic stewardship checklist, institutional support, point French Title: Utilisation d'une enquête longitudinale sur la prévalence ponctuelle des antibiotiques (PPS) pour conduire des programmes de gestion des antimicrobiens dans un hôpital tertiaire nigérian Contexte: La gestion des antimicrobiens (AMS) offre un moyen de lutter contre la résistance aux antimicrobiens (RAM). Malheureusement, au Nigéria, comme dans certains autres pays à revenu faible ou intermédiaire (PRFI), la pratique de la MGS a été médiocre en raison d'un soutien institutionnel insuffisant, entre autres facteurs. Des Longitudinal PPS for AMS programmes efforts ont été faits pour remédier à cette situation en collaborant avec la direction de l'hôpital national d'Abuja, au Nigéria, en utilisant les informations sur les prescriptions d'antibiotiques obtenues grâce à une enquête ponctuelle répétée de prévalence.Méthodologie: Deux séries d'antibiotiques PPS ont été menées en 2015 et 2017 en utilisant le format Global Point Prevalence Survey (G-PPS). Des données ont été recueillies auprès de tous les patients hospitalisés recevant des antibiotiques le jour sélectionné de l'étude, y compris les caractéristiques des patients, les détails de la prescription d'antimicrobiens, les résultats de laboratoire et les informations sur un ensemble d'indicateurs de qualité. Les données ont été téléchargées sur une application en ligne G-PPS hébergée à l'Université d'Anvers en Belgique à des fins de validation, d'analyse et rapports.Résultats: Les données PPS ont montré que la prévalence de l'utilisation d'antibiotiques à l'échelle de l'hôpital est passée de 58% en 2015 à 61% en 2017. La prophylaxie chirurgicale au-delà de 24 heures est également passée de 88 à 90% en 2015 à 100% en 2017, et seule une minorité de thérapies a été soutenue par entrée de laboratoire pour le diagnostic et la surveillance; 22% en 2015 et 5% en 2017.Conclusion: Ces résultats ont été utilisés pour un engagement fondé sur des données probantes avec la direction afin de soutenir officiellement les activités AMS à l'hôpital. Les résultats positifs ont été la reconstitution formelle et l'inauguration du comité AMS en 2018 ainsi que la publication d'une déclaration de politique formelle par l'hôpital en 2020. La facilité et la disponibilité gratuite de la méthodologie Global PPS la rend idéale pour conduire le programme de gestion des antimicrobiens (ASP) en PRFI comme le Nigéria. Mots clés: liste de contrôle pour la gestion des antibiotiques, soutien institutionnel, enquête ponctuelle de prévalence, déclaration de politique prevalence survey, policy statement

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Control of Vancomycin-Resistant Enterococci at a Community Hospital: Efficacy of Patient and Staff Cohorting

Infection Control and Hospital Epidemiology ◽

10.1086/501598 ◽

1999 ◽

Vol 20 (2) ◽

pp. 106-109 ◽

Cited By ~ 58

Author(s):

Elise M. Jochimsen ◽

Laurie Fish ◽

Kelly Manning ◽

Sally Young ◽

Daniel A. Singer ◽

...

Keyword(s):

Community Hospital ◽

Point Prevalence ◽

Control Measures ◽

Prevalence Survey ◽

Infection Control Measures ◽

Contact Isolation ◽

Point Prevalence Survey ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

The Impact

AbstractObjective:To evaluate the efficacy of patient and staff cohorting to control vancomycin-resistant enterococci (VRE) at an Indianapolis community hospital.Design:To interrupt transmission of VRE, a VRE point-prevalence survey of hospital inpatients was conducted, and VRE-infected or -colonized patients were cohorted on a single ward with dedicated nursing staff and patient-care equipment. To assess the impact of the intervention, staff compliance with contact isolation procedures was observed, and the VRE point-prevalence survey was repeated 2 months after the cohort ward was established.Results:Following the establishment of the cohort ward, VRE prevalence among all hospitalized inpatients decreased from 8.1% to 4.7% (25 positive cultures among 310 patients compared to 13 positive cultures among 276 patients,P=.14); VRE prevalence among patients whose VRE status was unknown before cultures were obtained decreased from 5.9% to 0.8% (18 positive cultures among 303 patients compared to 2 positive cultures among 262 patients,P=.002); and observed staff-patient interactions compliant with published isolation recommendations increased (5 [22%] of 23 interactions compared to 36 [88%] of 41 interactions,P<.0001).Conclusions:Our data suggest that, in hospitals with endemic VRE or continued VRE transmission despite implementation of contact isolation measures, establishing a VRE cohort ward may be a practical and effective method to improve compliance with infection control measures and thereby to control epidemic or endemic VRE transmission.

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Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211035827 ◽

2021 ◽

pp. 175717742110358

Author(s):

Sailesh Kumar Shrestha ◽

Swarup Shrestha ◽

Sisham Ingnam

Keyword(s):

Prevention And Control ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

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A prospective antibiotic point prevalence survey in two primary referral hospitals during and after pilgrims stay in Madinah, Saudi Arabia

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v19i2.23 ◽

2020 ◽

Vol 19 (2) ◽

pp. 391-399

Author(s):

Yaser M. ◽

Ahmad K. Aljabri ◽

Faisal N. Alsaadi ◽

Lamiaa M. Rizk ◽

Renad Y. Alahmadi ◽

...

Keyword(s):

Quality Improvement ◽

Antibiotic Therapy ◽

Prevalence Rate ◽

Antibiotic Use ◽

Point Prevalence ◽

Antibiotic Prescribing ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Significant Difference ◽

Referral Hospitals

Purpose: To assess current patterns of antibiotic use by carrying out two point-prevalence surveys (PPS) in Madinah after the return of hajj pilgrims from Makkah and when Madinah is free from pilgrims. Methods: In September 2016 and November 2016, a prospective PPS was conducted on two separate dates (during the hajj pilgrims stay in Madinah and after they leave). Data on antibiotics use were generated during these two periods. This involved an audit from all the departments of two referral hospitals (King Fahad Hospital (KFH) - 425 beds, and Al Ansar Hospital - 100 beds) of inpatients records. Data were collected using standard forms adapted from the European Centre for Disease Control (ECDC). Results: A total of 675 inpatients were included in PPS; among them, 332 (49.18 %) patients were receiving antibiotic therapy. In September 2016, 168 patients were treated with antibiotics, with a prevalence rate of 50.60 %, whereas, in November 2016, the prevalence rate was 49.40 %. Overall, 198 patients were identified in surgical wards, of which 132 patients (66.6 %) were receiving antibiotic therapy; 121 patients in ICU of which 70 patients (57.8 %) received antibiotics; 13 patients in other wards of which 6 (46.1 %) received antibiotic treatment; and 343 patients in medical wards of which 126 patients (36.7 %) were treated with antibiotics. There was no significant difference in prevalence of antibiotic prescribing between the two surveys (Pearson Chi-square test, p = 0.56) and with regards to patient age between the two surveys (Mann-Whitney U-test, p = 0.32). Conclusion: The results demonstrate that antibiotic use with adherence to hospital guidelines and PPS helps in identifying targets for quality improvement. Moreover, to escalate the prudent use of antibiotics in hospitals, PPS provides a useful tool. Furthermore, this survey provides a background to evaluate antibiotic use by a standardized methodology. Keywords: Point prevalence survey, Antibiotic use, Prescribing practices, Antibiotic resistance, Quality improvement, Antibiotic stewardship, Hajj, Pilgrims

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Correlation Between Tennessee Antibiotic Use Point Prevalence Survey and NHSN AUR Module in Four Acute Care Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1326 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S511-S511

Author(s):

Christopher Evans ◽

Raphaelle Beard ◽

Zina Gugkaeva ◽

Brooke Stayer ◽

Candice Simpson ◽

...

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Point Prevalence ◽

Prevalence Survey ◽

Point Prevalence Survey

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Variations in antibiotic use across India: multi-centre study through Global Point Prevalence survey

Journal of Hospital Infection ◽

10.1016/j.jhin.2019.05.014 ◽

2019 ◽

Vol 103 (3) ◽

pp. 280-283 ◽

Cited By ~ 6

Author(s):

S.K. Singh ◽

S. Sengupta ◽

R. Antony ◽

S. Bhattacharya ◽

C. Mukhopadhyay ◽

...

Keyword(s):

Antibiotic Use ◽

Point Prevalence ◽

Prevalence Survey ◽

Multi Centre Study ◽

Centre Study ◽

Point Prevalence Survey

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A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt

Antibiotics ◽

10.3390/antibiotics3030450 ◽

2014 ◽

Vol 3 (3) ◽

pp. 450-460 ◽

Cited By ~ 17

Author(s):

Maha Talaat ◽

Tamer Saied ◽

Amr Kandeel ◽

Gehad El-Ata ◽

Amani El-Kholy ◽

...

Keyword(s):

Antibiotic Use ◽

Point Prevalence ◽

Prevalence Survey ◽

Point Prevalence Survey

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Hospital-Wide Point Prevalence Survey of Inappropriate Use of Urinary Catheterization: Indications and Consequences

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv133.166 ◽

2015 ◽

Vol 2 (suppl_1) ◽

Cited By ~ 1

Author(s):

Pasri Maharom ◽

Apanaree Bhekasuta ◽

Aungsumalin Sricharoon ◽

Duangkamol Chatngern ◽

Kaimuk Thongyen ◽

...

Keyword(s):

Point Prevalence ◽

Urinary Catheterization ◽

Prevalence Survey ◽

Inappropriate Use ◽

Point Prevalence Survey

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Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey

BMJ Open ◽

10.1136/bmjopen-2020-042819 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042819

Author(s):

Jeremiah Seni ◽

Siana G Mapunjo ◽

Rachel Wittenauer ◽

Richard Valimba ◽

Andy Stergachis ◽

...

Keyword(s):

Antimicrobial Susceptibility ◽

Susceptibility Testing ◽

Antibiotic Use ◽

Point Prevalence ◽

Referral Hospital ◽

Antimicrobial Use ◽

Prevalence Survey ◽

Regional Referral Hospital ◽

Point Prevalence Survey ◽

Referral Hospitals

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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