Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals.

Abdul Haseeb,Khawlah Saad Almuqati,Mahmoud Essam Elrggal,Maali Zayed Almutiri,Afnan Owedah Alshomrani,Saleh Alghamdi,Ahmad Jamal Mahrous,Bashair Rjyan Alqethami,Hani Saleh Faidah,Muhammad Shahid Iqbal,Manal Algethamy,Hind Saeed Alotibi,Aziz Sheikh,Ghaidaa Ali Alhazmi,Asim Abdulaziz Khogeer,Zikria Saleem,Amjad Abdullah Albishi

doi:10.3390/ijerph19010254

Abstract

(1) Background: Inappropriate use of antimicrobials and subsequently rise of antimicrobial resistance (AMR) remains a major public health priority. Over-prescribing of broad-spectrum antibiotics is one of the main contributing factors for the emergence of AMR. We sought to describe antimicrobial prescribing trends among patients in public hospitals in Makkah hospitals. (2) Method: We undertook a point prevalence survey (PPS) in six hospitals in Makkah, Saudi Arabia, from January 2019 to July 2019. The survey included all the inpatients receiving antimicrobials on the day of PPS. Data was collected using the Global point prevalence survey (PPS) tool developed by the University of Antwerp, Belgium. (3) Results: Of 710 hospitalized patients, 447 patients (61.9%) were treated with one or more antimicrobials during the study period. The average bed occupancy among six hospitals was 74.4%. The majority of patients received antimicrobials parenterally (90.3%). Of the total prescribed antimicrobials, 415 (53.7%) antimicrobials were used in medical departments, 183 (23.7%) in surgical departments, and 175 (22.6%) in ICUs. Pneumonia (17.3%), skin and soft tissue infections (10.9%), and sepsis (6.6.%) were three common clinical indications. Ceftriaxones were the most commonly used antibiotics that were prescribed in 116 (15%) of patients, followed by piperacillin, with an enzyme inhibitor in 84 (10.9%). (4) Conclusion: There was a high prevalence of antibiotic use in the hospitals of Makkah, which could be a potential risk factor for the incidence of resistant strains, particularly MRSA infection. Public health decision-makers should take these findings into consideration to update national policies for antibiotic use in order to reduce the risks of further increases of AMR.

Highlights

Antimicrobials are commonly used to treat or prevent bacterial infections
Most of the surveyed patients were admitted to medical departments (53.7%), followed by surgical wards (23.7%) and intensive care units (ICUs) (22.6%)
Point prevalence studies can spot the light on areas of misuse and guide in developing point prevalence studies can spot the light on areas of misuse and guide in developing national national antibiotic antibiotic use use strategies strategies [4]

Summary

Introduction

Some antimicrobials may be used inappropriately—for example, if not indicated or suboptimal selection, dose, route of administration, or duration [1,2]. Antimicrobial selection pressure contributes to the emergence and spread of antimicrobial resistance (AMR) [3,4]. In the last few decades, the inappropriate use of antimicrobials and the rise of AMR has emerged as major global public health concern [5]. In an attempt to address the risks posed by AMR, the World Health Organization (WHO) recommends the initiation of antimicrobial stewardship programs (ASPs) to identify and monitor antimicrobial use and reduce the burden of AMR [6,7]. In the Gulf region, there is still a lack of knowledge and worrying attitudes and belief concerning antimicrobial use [8]

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Conclusion