ABSTRACT
Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.
Subject(s)
Anti-Bacterial Agents , Escherichia coli , Humans , Male , Female , Anti-Bacterial Agents/therapeutic use , Cross-Sectional Studies , Tertiary Care Centers , Ceftriaxone , Prevalence , Nepal/epidemiologyABSTRACT
SETTING: Tribhuvan University Teaching Hospital, Kathmandu, Nepal. OBJECTIVES: 1) To report the number and proportion of Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019. DESIGN: This was a hospital-based, cross-sectional study using secondary data. RESULTS: Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). Pseudomonas showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died. CONCLUSION: The study showed a high prevalence of Pseudomonas and Acinetobacter and the emergence of Stenotrophomonas in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.
LIEU: Hôpital universitaire de Tribhuvan, Katmandu, Népal. OBJECTIFS: 1) Rapporter le nombre et le pourcentage d'espèces de Pseudomonas, Acinetobacter, Burkholderia et Stenotrophomonas (PABS) parmi les patients admis en soins intensifs (ICU) avec culture d'expectorations ; et 2) évaluer les profils de résistance antimicrobienne, les caractéristiques démographiques et cliniques associées à la résistance à au moins un antibiotique et le devenir des patients après un séjour en ICU parmi ceux infectés par une espèce PABS admis à l'hôpital entre le 14 avril 2018 et le 13 avril 2019. MÉTHODE: Étude transversale hospitalière réalisée en utilisant des données secondaires. RÉSULTATS: Sur 166 patients dont les échantillons d'expectorations ont été mis en culture, 104 (63%) présentaient une croissance bactérienne dont 67 (64%) étaient associées à la présence d'espèces PABS. Parmi les cultures positives, PABS étaient présents dans respectivement 32 (30,7%), 31 (29,8%), une (1%) et trois (2,8%) cultures. Pseudomonas a été associé à un niveau de résistance élevé à la lévofloxacine (61%), à la céfépime (50%) et à l'amikacine (50%). Acinetobacter était majoritairement résistant à la céfépime (95%), à l'imipénème (92%) et à la lévofloxacine (86%). Sur les 67 patients présentant une infection à PABS, 32 (48%) sont décédés. CONCLUSION: L'étude a montré une forte prévalence de Pseudomonas et Acinetobacter, ainsi que l'émergence de Stenotrophomonas dans les échantillons de culture d'expectorations des patients admis en ICU. Cela souligne le besoin de suivi des espèces PABS et des profils de résistance associés afin de réduire la mortalité des patients admis en ICU.
