Point prevalence survey of antimicrobial use in a Malaysian tertiary care university hospital

Jamaluddin, Nurul Adilla Hayat and Periyasamy, Petrick and Lau, Chee Lan and Ponnampalavanar, Sasheela Sri La Sri and Lai, Pauline Siew Mei and Ramli, Ramliza and Tan, Toh Leong and Kori, Najma and Yin, Mei Kuen and Azman, Nur Jannah and James, Rodney and Thursky, Karin and Naina-Mohamed, Isa (2021) Point prevalence survey of antimicrobial use in a Malaysian tertiary care university hospital. Antibiotics-Basel, 10 (5). ISSN 2079-6382, DOI https://doi.org/10.3390/antibiotics10050531.

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Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/beta-lactamase inhibitor (14.8%), piperacillin/beta-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients' notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.

Item Type: Article
Funders: Universiti Malaya, Pfizer Independent Grants for Learning and Change (IGLC)[40867041], The Joint Commission provides administrative oversight for the programme
Uncontrolled Keywords: Antimicrobial;Point prevalence;Compliance;Risk;Prescribing
Subjects: R Medicine
R Medicine > RB Pathology
R Medicine > RB Pathology > Theories of disease. Etiology. Pathogenesis
R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 14 Sep 2022 07:31
Last Modified: 14 Sep 2022 07:31
URI: http://eprints.um.edu.my/id/eprint/34525

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