Abstract
Antimicrobial resistance is one of the key issues limiting the successful treatment of infectious diseases and associated with adverse medical, social and economic consequences on a global scale. The present study aims to evaluate antimicrobials prescribing patterns and assess progress in quality indicators in Russian multidisciplinary hospitals using three repetitive point prevalence studies (PPSs) over 4 years (Global-PPS 2015, 2017 and 2018). Out of 13,595 patients from 21 hospitals surveyed over the three time points, 3542 (26.14%) received antimicrobials, predominantly third-generation cephalosporins (44.7% in 2015, 34.1% in 2017 and 41.8% in 2018). Compliance with the hospital antibiotic guidelines was 74.8%, 66.8% and 74.3%, respectively. Indication for treatment was recorded in 72.6%, 84.1% and 82.6%, while stop/review date was documented only in 40.5%, 46.5% and 61.1% of cases. Perioperative antibiotic prophylaxis exceeded 1 day in 92%, 84% and 81% of cases. Targeted therapy rate at all time points did not exceed 15.1%, treatment based on the biomarkers rate—19.9%. For the part of PPS-2017 and 2018 analyzed in dynamics, no prominent trends were noted. The results of the project provide the basis for the development of appropriate antimicrobial stewardship programs tailored according to local practices for each hospital in the project.
Highlights
The prevalence of antimicrobials prescription was calculated by dividing the number of patients treated with antimicrobial drugs (AMDs) by the total number of inpatients surveyed
We present results of three consecutive point prevalence studies (PPSs) undertaken in Russian multidisciplinary hospitals in 2015, 2017 and 2018
PPSs included in the publication were carried out by a uniform methodology, our possibility to carry out a comparative assessment of the results over the years was limited as most hospitals participated only once
Summary
Enterobacterales producing extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumanii and methicillin-resistant strains of Staphylococcus aureus has been observed in Russian hospitals [3,4,5,6]. According to a multicenter study [3], covering 49 hospitals in 26 cities of the Russian Federation, the percentage of ESBL-producing nosocomial strains of entrobacteria in 2015-2016 exceeded 67% in addition to high levels of resistance to non-beta-lactam such as aminoglycosides (up to 61.1%) and fluoroquinolones (69.5%). Even though carbapenems remain active against the majority of nosocomial enterobacteria strains (89.5%–90%), the increase in the proportion of isolates resistant to drugs of this group due to the production of carbapenemases (14.4%) is alarming. An increase in resistance to carbapenems was noted among nosocomial isolates of P. aeruginosa Point prevalence studies (PPSs) have established themselves as a convenient, low-cost, and at the same time standardized and validated tool for monitoring the prescribing of drugs in inpatients [8]
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