A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan: findings and implications.
Zikria SaleemMuhammad Azmi HassaliFurqan Khurshid HashmiBrian B GodmanOmar Akhlaq BhuttaPublished in: Hospital practice (1995) (2019)
Background: The extensive use of broad-spectrum antimicrobials in immunocompromised patients is inevitable in situations where culture and sensitivity testing is challenging. However, their overuse leads to an increase in antimicrobial resistance (AMR), which is a growing concern. Method: A repeated point prevalence survey (PPS) was conducted to assess the pattern of antimicrobial prescribing in a specialized cancer care hospital in Pakistan using the methodology employed by the European Centre of Disease Prevention and Control. Results: Out of 313 hospitalized patients, 156 (49.8%) were prescribed one or more antimicrobials, 82 (50.9) in 2017 and 74 (48.7) in 2018. The average bed occupancy in the hospital was 80.3%. Fever in neutropenic patients (20.2%), lower respiratory tract infections (17.8%), and sepsis (14.9%) were the three most common clinical indications. The total number of prescribed antimicrobials was 242, of whom, 41 (16.9%) were given orally and 201 (83.1%) were given parenterally. The most commonly used antimicrobials were piperacillin plus enzyme inhibitor (31.8%), meropenem (7.9%), ceftriaxone (6.2%) and vancomycin (6.2%). Of the total prescribed antimicrobials, 42 (17.3%) antimicrobials were used in surgical departments, 89 (36.8) in adult medical departments, 73 (30.1%) in pediatric medical departments and 38 (15.7) in the intensive care unit (ICU). In addition to these antibacterials, there was relatively high use of antivirals (acyclovir; 4.1%) and antifungals (fluconazole; 3.7%, amphotericin B; 2.9%). Conclusion: The study concluded that broad-spectrum antimicrobial usage in cancer hospitals in Pakistan is high, which can be a risk factor for the emergence of AMR. Repeated PPS is a fruitful way to maintain a focus on inappropriate antimicrobial use and develop pertinent intervention programs targeteing specific issues to improve future use.
Keyphrases
- healthcare
- end stage renal disease
- antimicrobial resistance
- staphylococcus aureus
- ejection fraction
- chronic kidney disease
- respiratory tract
- newly diagnosed
- primary care
- palliative care
- peritoneal dialysis
- intensive care unit
- prognostic factors
- risk factors
- emergency department
- acute kidney injury
- squamous cell carcinoma
- patient reported outcomes
- candida albicans
- cross sectional
- methicillin resistant staphylococcus aureus
- papillary thyroid
- squamous cell