A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan

findings and implications

Zikria Saleem, Mohamed Azmi Hassali, Furqan Khurshid Hashmi, Brian Godman, Omar Akhlaq Bhutta

Research output: Contribution to journalArticle

Abstract

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.
Original languageEnglish
Pages (from-to)149-154
Number of pages6
JournalHospital Practice
Volume47
Issue number3
Early online date10 Jun 2019
DOIs
Publication statusPublished - 27 Jun 2019

Fingerprint

Cancer Care Facilities
meropenem
Pakistan
Bed Occupancy
Piperacillin
Acyclovir
Ceftriaxone
Fluconazole
Immunocompromised Host
Amphotericin B
Enzyme Inhibitors
Vancomycin
Centers for Disease Control and Prevention (U.S.)
Respiratory Tract Infections
Antiviral Agents
Intensive Care Units
Sepsis
Fever
Pediatrics
Surveys and Questionnaires

Keywords

  • point prevalence study
  • cancer
  • antimicrobial use
  • Pakistan
  • antimicrobial resistance

Cite this

Saleem, Zikria ; Hassali, Mohamed Azmi ; Hashmi, Furqan Khurshid ; Godman, Brian ; Bhutta, Omar Akhlaq. / A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan : findings and implications. In: Hospital Practice. 2019 ; Vol. 47, No. 3. pp. 149-154.
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abstract = "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.",
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A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan : findings and implications. / Saleem, Zikria ; Hassali, Mohamed Azmi; Hashmi, Furqan Khurshid; Godman, Brian; Bhutta, Omar Akhlaq.

In: Hospital Practice, Vol. 47, No. 3, 27.06.2019, p. 149-154.

Research output: Contribution to journalArticle

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T1 - A repeated point prevalence survey of antimicrobial use in specialized cancer care hospital of Pakistan

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