A multicentre point prevalence survey of patterns and quality ofantibiotic prescribing in Indonesian hospitals

3/10/2021 12:00:00 AM

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Authors: Ralalicia Limato, Erni J. Nelwan, Manzilina Mudia, Justin de Brabander, Helio Guterres, Enty, Ifael Y. Mauleti, Maria Mayasari, Iman Firmansyah, May Hizrani, Raph L. Hamers

Publication date:  10 Maret 2021

JAC-Antimicrobial Resistance

Volume: 3 (2); 3-10

Link: https://academic.oup.com/jacamr/article/3/2/dlab047/6252879

 

Abstract

Background: The global emergence of antimicrobial resistance is driven by antibiotic misuse and overuse. However, systematic data in Indonesian hospitals to adequately inform policy are scarce.

Objectives: To evaluate patterns and quality indicators of antibiotic prescribing in six general hospitals in Jakarta, Indonesia.

Methods: We conducted a hospital-wide point prevalence survey (PPS) between March and August 2019, using Global-PPS and WHO-PPS protocols. The analysis focused on antibacterials (antibiotics) for systemic use.

Results: Of 1602 inpatients, 993 (62.0%) received ≥1 antimicrobial. Of 1666 antimicrobial prescriptions, 1273 (76.4%) were antibiotics. Indications comprised community-acquired infections (42.6%), surgical prophylaxis (22.6%), hospital-acquired infections (18.5%), medical prophylaxis (9.6%), unknown (4.6%) and other (2.1%). The most common reasons for antibiotic prescribing were pneumonia (27.7%), skin and soft tissue infections (8.3%), and gastrointestinal prophylaxis (7.9%). The most prescribed antibiotic classes were third-generation cephalosporins (44.3%), fluoroquinolones (13.5%), carbapenems (7.4%), and penicillins with β-lactamase inhibitor (6.8%). According to the WHO AWaRe classification, Watch antibiotics accounted for 67.4%, followed by 28.0% Access and 2.4% Reserve. Hospital antibiotic guidelines were not available for 28.1% of prescriptions, and, where available, guideline compliance was 52.2%. Reason for the antibiotic prescription, stop/review date and planned duration were poorly documented. Culture-guided prescriptions comprised 8.1% of community-acquired infections and 26.8% of hospital-acquired infections.

Conclusions: Our data indicate a high rate of empirical use of broad-spectrum antibiotics in Indonesian hospitals, coupled with poor documentation and guideline adherence. The findings suggest important areas for antimicrobial stewardship interventions.