Molecular epidemiology and genomic plasticity of ESBL-producing and carbapenem-non-susceptible Klebsiella pneumoniae in a tertiary care hospital in northern Thailand.

Chicken intestinal Escherichia coli are a reservoir for virulence and antimicrobial resistance (AMR) genes that are often carried on incompatibility group F (IncF) plasmids. The rapid transfer of these plasmids between bacteria in the gut contributes to the emergence of new multidrug-resistant and virulent bacteria that threaten animal agriculture and human health. Thus, the aim of the present study was to determine whether live bacterial prophylactics could affect the distribution of large virulence plasmids and AMR in the intestinal tract and the potential role of smRNA in this process. In this study, we tested ∼100 randomly selected E. coli from pullet feces (n = 3 per group) given no treatment (CON), probiotics (PRO), a live Salmonella vaccine (VAX), or both (P + V). E. coli isolates were evaluated via plasmid profiles and several phenotypic (siderophore production and AMR), and genotypic (PCR for virulence genes and plasmid typing) screens. P + V isolates exhibited markedly attenuated siderophore production, lack of AMR and virulence genes, which are all related to the loss of IncF and ColV plasmids (P < 0.0001). To identify a causal mechanism, we evaluated smRNA levels in the ceca mucus and found a positive association between smRNA concentrations and plasmid content, with both being significantly reduced in P + V birds compared to other groups (P < 0.01). To test this positive association between IncF plasmid transfer and host smRNA concentration, we evenly pooled smRNA per group and treated E. coli mating pairs with serial concentrations of smRNA in vitro. Higher smRNA concentrations resulted in greater rates of IncF plasmid transfer between E. coli donors (APEC O2 or VAX isolate IA-EC-001) and recipient (HS-4) (all groups; P < 0.05). Finally, RNAHybrid predictive analyses detected several chicken miRNAs that hybridize with pilus assembly and plasmid transfer genes on the IncF plasmid pAPEC-O2-R. Overall, we demonstrated P + V treatment reduced smRNA levels in the chicken ceca, which was associated with a reduction in potentially virulent E. coli. Furthermore, we propose a novel mechanism in which intestinal smRNAs signal plasmid exchange between E. coli. Investigations to understand the changes in bacterial gene expression as well as smRNAs responsible for this phenomenon are currently underway.

To observe the early reperfusion therapy status for patients with ST elevation acute myocardial infarction (STEMI) hospitalized in tertiary and secondary hospitals in Henan province. Baseline data, early reperfusion treatment and in-hospital mortality of STEMI patients hospitalized in 17 hospitals in Henan province (8 tertiary hospitals, 9 secondary hospitals) from June 2011 to June 2012 were obtained using a uniformed questionnaire. One thousand six hundred and eighty six patients were enrolled, of which 886 patients were hospitalized in tertiary hospitals and 880 patients were early hospitalized in secondary hospitals. Six hundred and fifty four patients (38.8%, 654/1 686) underwent early reperfusion therapy (543 with thrombolysis and 111 with primary percutaneous coronary intervention (PCI)). There was no difference in the proportion of early reperfusion therapy between tertiary and secondary hospitals (40.1% (355/886) vs. 37.4% (299/800), P = 0.257). The median time from symptom onset to first medical contact, door-to-needle and door-to-balloon was 132 min, 18 min and 60 min, respectively. The median time from symptom onset to first medical contact (150 min vs. 120 min, P = 0.001), door-to-needle (30 min vs. 18 min, P = 0.003) and symptom onset-to-thrombolysis (3.5 h vs. 2.7 h, P = 0.001) were significantly longer in tertiary hospitals than in secondary hospitals. No difference was found in median time of door-to-balloon, symptom onset-to-primary PCI or symptom onset-to-elected PCI between tertiary and secondary hospitals (all P > 0.05). The proportion of door-to-needle ≤ 30 min was lower in tertiary hospitals than in secondary hospitals (46.4% (84/181) vs. 62.2% (153/246), P = 0.001). However, there was no difference in the proportion of door-to-balloon ≤ 90 min between tertiary and secondary hospitals (58.8% (60/102) vs. 57.1% (4/7), P = 1.000). In-hospital mortality was also similar between tertiary and secondary hospitals (5.8% (51/886) vs. 5.5% (44/800), P = 0.820). Early reperfusion rate is low, and thrombolysis is the main early reperfusion therapy in both tertiary and secondary hospitals in Henan province. Tertiary hospitals did not take advantage of their primary PCI capability. There is great room for improvement in early reperfusion therapy in tertiary and secondary hospitals.

The development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.

Introduction: Attrition rates in various cadres are a major issue in tertiary care facilities; attrition rates are one of the important factors used by accrediting bodies to assess the efficacy of Quality services provided by accredited hospitals. Human resource difficulties, such as lowering the attrition rate, are also key leadership challenges in any firm. The challenge of motivating and retaining health workers is crucial, since low motivation and high drop-out rates can impact overall performance, cost, and sustainability. Tertiary care hospital has recognized the importance of this issue and are making significant efforts to avoid attrition. The goal of this review is to understand the many reasons for staff attrition recognized by selected Tertiary Care Hospital. Tertiary care hospital Leaders would find the reasons indicated by Tertiary care hospital and the attrition rate reported in this study to be especially useful in addressing attrition in their individual Tertiary care hospital. Aim: This study was done in order to find to Rate of attrition of Doctors &amp; nurses in a tertiary hospital and to determine the Reasons behind the attrition for Doctors &amp;nurses leaving the hospital Objectives is to explore the reasons of Doctors &amp; Nurses abandoning Tertiary Care Hospital, to determine the attrition rate of health-care personnel, to Enhancing staff retention for the benefit of organizational growth. Methodology: An analysis will be carried out based on the Exit interviews conducted over a 6-month period indicated the attrition rate and the reasons for it. A research was conducted to better understand the Tertiary Care Hospital's experience and the reasons for attrition. Results: Taking into account the results, greater opportunities, and further study, Marriage, caring for a family, working for the government, relocating, a recommendation from a doctor, discipline, a health issue, go back to your hometown A number of factors were examined, including improper document submission, travel and distance, job description &amp; job role changes, higher salaries and others. Based on the findings, the organization is committed to taking ownership of preventing obstacles to the professional development, learning, and learning of healthcare personnel. As people are the assets of any organization that enable it to achieve its goals and set benchmarks, the hospital administration decided to streamline the HR Management system, which will be very advantageous in keeping employees and providing quality services. Tertiary care hospital administrators would find the reasons indicated by Tertiary care hospital and the attrition rate reported in this study to be especially useful in addressing attrition in their individual Tertiary care hospital.

Background: Urinary tract infections (UTIs) are the most important cause of mortality and morbidity affecting all age groups with an estimated 150 million cases occurring globally per year. Resistance to antibiotics is highly prevalent in bacterial isolates causing UTI. Objectives: To observe the isolation of gram positive bacteria causing UTIs and determine their resistance pattern to antibiotics. Methods: A retrospective study was conducted in BPKIHS from August 2009- August 2010. A total of 11022 urine samples from patients who visited BPKIHS were analyzed. All specimens were inoculated on routine culture media. Bacterial isolates were identified by conventional bacteriological methods. Susceptibility testing was performed by standard methods as recommended by clinical laboratory standard institute. Results: A total of 459 gram positive uropathogens were isolated. Altogether 5 different gram positive bacteria were isolated among which Staphylococcus aureus (47%) was the most predominant organism followed by Enterococcus species (34%), Enterococcus faecalis (18%), and Coagulase-negative Staphylococci (1%). UTI caused by gram positive uropathogens was seen in 68.8% females as compared to 31.2% males. Multidrug resistance (MDR) isolates accounted for 308 out of 459 isolates (67.10%). Multidrug resistance was commonest with Enterococcus spp (71.5%) followed by Streptococcus spp (66.6%). Drugs, which retained usefulness for Gram-positive isolates were vancomycin, nitrofurantoin, ciprofloxacin and norfloxacin. Conclusion: The study revealed that bacterial resistance in gram positive uropathogens in tertiary hospital in eastern region continues to be a great problem. So, regular monitoring of emergence of resistance is highly recommended and specific antibiotics should be given only after the laboratory results are available. Health Renaissance, January-April 2013; Vol. 11 No.1; 119-124 DOI: http://dx.doi.org/10.3126/hren.v11i2.8218

Introduction. Carbapenem-resistant members of the family Enterobacteriaceae are emerging as a global public-health threat and cause substantial challenges in clinical practice.Gap Statement. There is a need for increased and continued genomic surveillance of antimicrobial resistance genes globally in order to detect outbreaks and dissemination of clinically important resistance genes and their associated mobile genetic elements in human pathogens.Aim. To describe the resistance mechanisms of carbapenem-resistant Escherichia coli.Methods. Rectal swabs from neonates and newly diagnosed human immunodeficiency virus (HIV) infected adults were collected between April 2017 and May 2018 and screened for faecal carriage of carbapenamases and OXA-48 producing members of the family Enterobacteriaceae. Bacterial isolates were identified using matrix assisted laser desorption ionization time of flight mass spectrometry. Antimicrobial susceptibility testing was performed by E-test. Whole genomes of carbapenem-resistant E. coli were investigated using a hybrid assembly of Illumina and Oxford Nanopore Technologies sequencing reads.Results. Three carbapenem-resistant E. coli were detected, two from neonates and one from an HIV infected adult. All three isolates carried blaNDM-5. Two E. coli from neonates belonged to ST167 and blaNDM-5 co-existed with blaCTX-M-15 and blaOXA-01, and all were carried on IncFIA type plasmids. The E. coli from the HIV infected adult belonged to ST2083, and carried blaNDM-5 on an IncX3 type plasmid and blaCMY-42 on an IncI type plasmid. All blaNDM-5 carrying plasmids contained conjugation related genes. In addition, E. coli from the HIV infected adult carried three more plasmid types; IncFIA, IncFIB and Col(BS512). One E. coli from a neonate also carried one extra plasmid Col(BS512). All three E. coli harboured resistance genes to fluoroquinolone, aminoglycosides, sulfamethoxazole, trimethoprim, macrolides and tetracycline, carried on the IncFIA type plasmid. Furthermore, E. coli from the neonates carried a chloramphenicol resistance gene (catB3), also on the IncFIA plasmid. All three isolates were susceptible to colistin.Conclusion. This is the first report, to our knowledge, from Tanzania detecting blaNDM-5 producing E. coli. The carbapenemase gene was carried on an IncFIA and IncX3 type plasmids. Our findings highlight the urgent need for a robust antimicrobial resistance (AMR) surveillance system to monitor and rapidly report on the incidence and spread of emerging resistant bacteria in Tanzania.

Antimicrobial resistance (AMR) is a natural evolutionary process in bacteria that is accelerated by selection pressure from the frequent and irrational use of antimicrobial drugs. This study aimed to determine the variations in AMR patterns of priority bacterial pathogens at a tertiary care hospital in the Gaza Strip during pre- and post-COVID-19 pandemic. This is a retrospective observational study to determine the AMR patterns of bacterial pathogens at a tertiary hospital in the Gaza Strip in the post-COVID-19 pandemic period compared to the pre-COVID-19 period. Positive-bacterial culture data of 2039 samples from pre-COVID-19 period and 1827 samples from post-COVID-19 period were obtained from microbiology laboratory records. These data were analysed and compared by Chi square test using Statistical Package for Social Sciences (SPSS) Program. Gram-positive and Gram-negative bacterial pathogens were isolated. Escherichia coli was the most prevalent in both study periods. The overall AMR rate was high. There was a statistically significant increase in resistance to cloxacillin, erythromycin, cephalexin, co-trimoxazole and amoxicillin/clavulanic acid in the post-COVID-19 period compared to pre-COVID-19 period. There was also a significant decrease in resistance to cefuroxime, cefotaxime, gentamicin, doxycycline, rifampicin, vancomycin and meropenem in the post-COVID-19 period. During the COVID-19 pandemic, the AMR rates of restricted and noncommunity-used antimicrobials declined. However, there was an increase in AMR to antimicrobials used without medical prescription. Therefore, restriction on the sale of antimicrobial drugs by community pharmacies without a prescription, hospital antimicrobial stewardship and awareness about the dangers of extensive use of antibiotics are recommended.

BackgroundAntibiotic resistance is a worldwide problem. Prior studies on patterns of resistance in Zambia depended on laboratory methods that lacked standardization. UTH is a 1,655-bed quaternary care hospital and the primary teaching hospital of Zambia. Since 2015, the microbiology laboratory has used Vitek 2 Compact (bioMerieux, Inc., France) for standardized detection of resistance.MethodsWe conducted a retrospective cross-sectional study of data collected on bacterial isolates analyzed from July 2015 to April 2017. We entered the data into WHONET 5.6 and aggregated it to develop hospital antibiograms. Due to high levels of resistance, we defined susceptible, intermediate, and resistant as >70%, 40–70%, and <40% of isolates sensitive to a drug, respectively. To improve usability, a version replacing the percent susceptible with these categories was developed.ResultsWe analyzed 2,019 isolates to identify susceptibility patterns to commonly used antibiotics at UTH. Escherichia coli and Klebsiella pneumoniae, the most commonly isolated Gram-negative (GN) organisms, were resistant to most drugs including ceftriaxone, indicating high rates of extended-spectrum β-lactamase production. Methicillin-resistant Staphylococcus aureus (MRSA) made up 37% of S. aureus isolates. MRSA and methicillin-susceptible S. aureus were resistant to trimethoprim/sulfamethoxazole, a commonly used drug at UTH. S. pneumoniae was resistant to most drugs against which it was tested.ConclusionMDROs were common at UTH with carbapenems indicated for empiric GN therapy. Further research should assess the extent and depth of antibiotic resistance in Zambia. Antibiograms provide critical information for clinicians to strategically use antibiotics.ReferencesCarroll M, Rangaiahagari A, Musabeyezu E, et al. Five-year antimicrobial susceptibility trends among bacterial isolates from a tertiary health-care facility in Kigali, Rwanda. Am J Trop Med Hyg. 2016;95(6):1277–83.Moremi N, Claus H, Mshana SE. Antimicrobial resistance pattern: a report of microbiological cultures at a tertiary hospital in Tanzania. BMC Infect Dis. 2016;16(1):756.Kumburu HH, Sonda T, Mmbaga BT, et al. Patterns of infections, aetiological agents and antimicrobial resistance at a tertiary care hospital in northern Tanzania. TM and IH. 2017;22(4):454–64.DisclosuresE. Heil, ALK-Abelló: Grant Investigator, Research grant. L. Hachaambwa, Centers for Disease Control and Prevention (CDC): Cooperative Agreement to Institution, Financial support for the work described in this abstract was made possible by a cooperative agreement award from the Centers for Disease Control and Prevention (CDC) to the University of Zambia and to the University of Maryland School of Medicine. J. K. Johnson, Q-Linea: Investigator, Research grant. Applied Biocode: Investigator, Research grant.

Backgroundβ-Lactam/β-lactamase inhibitors (BLBLIs) were introduced into clinical practice as an alternative to carbapenems for treating multi-drug–resistant Klebsiella pneumoniae infections. However, little is known about the relationship between BLBLI treatment and antimicrobial resistance. In this study, we investigated the trends and the temporal association between antibiotic use and antimicrobial resistance in K. pneumoniae isolates obtained between 2012 and 2016.MethodsData regarding quarterly consumption (total number of prescriptions per quarter) of all BLBLIs, all third-generation cephalosporins, and all fluoroquinolones at a tertiary care hospital were obtained from the Korean Health Insurance Review and Assessment Service. Susceptibility data (isolation rate of antibiotic resistance per quarter) were obtained from the existing database of the same tertiary hospital. Regression analysis was used to analyze annual trends and cross-correlations to assess the temporal association on a quarterly basis between antibiotic consumption and antibiotic resistance in K. pneumoniae.ResultsThe rate of resistance to piperacillin/tazobactam in K. pneumoniae significantly increased over the study period (p < 0.01). The consumption of all BLBLIs was also found to be significantly correlated with the rate of resistance to piperacillin/tazobactam (β = 0.66; p < 0.01), ceftazidime (β = 0.54; p = 0.02), and levofloxacin (β = − 0.60; p = 0.01) with two-quarter lags. Furthermore, the consumption of all third-generation cephalosporins was significantly correlated with rates of K. pneumoniae resistance to ceftazidime (β = 0.64; p < 0.01) with a two-quarter lag and levofloxacin (β = 0.50; p = 0.03) with a quarter lag. The consumption of all fluoroquinolones correlated with resistance rates to ceftazidime (β = 0.14; p < 0.01) with a two-quarter lag.ConclusionsThe rate of resistance to piperacillin/tazobactam in K. pneumoniae increased significantly over the study period and was significantly correlated with BLBLI consumption. While BLBLIs can potentially be utilized as an alternative to carbapenems, our findings reinforce concerns of resistance to these drugs. Further research is needed to understand the implications on resistance of utilizing BLBLIs as a carbapenem-sparing option.

Methicillin-resistant staphylococci are now recognized as a major cause of infectious diseases, particularly in hospitals. Molecular epidemiology is important for prevention and control of infection, but little information is available regarding staphylococcal infections in Northern Thailand. In the present study, we examined antimicrobial susceptibility patterns, detection of antimicrobial resistance genes, and SCCmec types of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS) isolated from patients in a hospital in Northern Thailand. The species of MRSA and MR-CoNS were identified using combination methods, including PCR, MALDI-TOF-MS, and tuf gene sequencing. The susceptibility pattern of all isolates was determined by the disk diffusion method. Antimicrobial resistance genes, SCCmec types, and ST239 were characterized using single and multiplex PCR. ST239 was predominant in MRSA isolates (10/23). All MR-CoNS (N=31) were identified as S. haemolyticus (N=18), S. epidermidis (N=3), S. cohnii (N=3), S. capitis (N=6), and S. hominis (N=1). More than 70% of MRSA and MR-CoNS were resistant to cefoxitin, penicillin, oxacillin, erythromycin, clindamycin, gentamicin, and ciprofloxacin. In MRSA isolates, the prevalence of ermA (78.3%) and ermB (73.9%) genes was high compared to that of the ermC gene (4.3%). In contrast, ermC (87.1%) and qacA/B genes (70.9%) were predominant in MR-CoNS isolates. SCCmec type III was the dominant type of MRSA (13/23), whereas SCCmec type II was more present in S. haemolyticus (10/18). Ten MRSA isolates with SCCmec type III were ST239, which is the common type of MRSA in Asia. This finding provides useful information for a preventive health strategy directed against methicillin-resistant staphylococcal infections.

BackgroundEfflux pump mediated antibiotic resistance is an unnoticed and undetected mechanism in clinical microbiology laboratory. RND efflux systems are known for aminoglycoside and tetracycline resistance whereas their role in carbapenem non-susceptibility is not established. The study was undertaken to investigate the role of efflux pump in providing resistance against carbapenems and their response against concentration gradient carbapenem stress on the transcriptional level of the AcrAB gene in the clinical isolates of Escherichia coli from a tertiary referral hospital of Northeast India.ResultsOut of 298 non-susceptible Escherichia coli isolates 98 isolates were found to have efflux pump mediated carbapenem non-susceptibility. Among them thirty-five were non carbapenemase producers and their expressional levels were verified using qRT-PCR under concentration gradient carbapenem stress. In this study, a strong correlation between ertapenem resistance and AcrA overexpression was observed which has not been reported previously. Further, it was observed that imipenem stress increased AcrB expression in Escherichia coli which holds the novelty of this study. Additionally, the transcription of AcrR was insistently increased which is much higher than the transcriptional level of AcrA under concentration gradient carbapenem stress condition.ConclusionThe study established that AcrAB pump is a relevant antibiotic resistance determinant in bacterial pathogen, has an important role in developing resistance against carbapenem group of antibiotics.

Antimicrobial stewardship (AMS) programmes are central to tackling antimicrobial resistance. Comparative evidence on how barriers differ between high-income countries (HICs) and low-/middle-income countries (LMICs) in tertiary care hospitals is limited. The review aims to identify and compare multilevel barriers to implementing AMS programmes in tertiary care hospitals in HICs and LMICs. We conducted a systematic scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. PubMed and Web of Science were searched for English-language primary studies from January 2015 to November 2025. Studies were considered eligible if they examined barriers to implementing AMS in adult inpatient services in tertiary care hospitals. Using a framework-based thematic approach, barriers were grouped into eight themes and mapped to individual, team, organizational, and system levels. Out of 2311 records, 57 studies met inclusion criteria (23 = HICs, 34 = LMICs). Knowledge, education, and confidence gaps were the most frequent barrier theme in both groups, reported in about three-quarters of studies. Staffing and resource constraints and organisational/governance barriers were also highly prevalent, particularly in LMIC hospitals. Workflow and documentation problems and data-system limitations were more prominent in HIC studies, whereas structural health system constraints were more prominent in LMICs. Qualitative and mixed-methods studies identified a broader range of barriers than surveys or observational designs. AMS implementation in tertiary hospitals is constrained by overlapping multilevel barriers that are broadly similar across income groups but differ in emphasis. Tailored strategies that jointly strengthen workforce capacity, infrastructure and governance are needed, with particular attention to system-level constraints in LMICs and workflow and data challenges in HICs.

Antibiotics are among the most used medicines globally, but antimicrobial resistance (AMR) threatens their effectiveness. The greatest mortality burden associated with AMR is in sub-Saharan Africa. However, antimicrobial prescribing practice and stewardship remain challenges in the African regions. Thus, this study aimed to evaluate and compare antibiotic utilization patterns in tertiary hospitals in Ethiopia during 2022. A retrospective cross-sectional study was conducted in adult wards of five public tertiary care hospitals in Ethiopia with a total of 3,283 beds. Data were retrieved from 807 randomly selected patient records using the online Kobo tool. Analysis utilized the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) (ATC/DDD) method. The result was presented using tables, charts, and text. A total of 2,718 drugs were prescribed to 807 patients with an average of 3.4 drugs per patient (range 1-7) during a total of 8638 bed-days. Of the total drugs prescribed, antibiotics account for 1,035 (38%), with an average of 1.3 (1,035/807) antibiotics per patient. Five hundred fifty-six (69%) patients were prescribed at least one antibiotic. The overall antibiotic consumption was 108 DDD/100 bed-days, 37.5/100 bed-days for hospital-acquired infections, and 32.8/100 bed-days for community-acquired infections. The rest were for prophylaxis purposes. The majority of antibiotics were prescribed in medical and surgical wards; 34.9/100 and 27.5/100 bed-days, respectively. The most prescribed antibiotics were ceftriaxone, metronidazole, and ceftazidime. Overall, the AWaRe "Watch" group antibiotics use occurred in 74% (73 DDD/100 bed-days) of total antibiotic consumption, which was higher than the WHO recommendation (at least 60% of total antibiotic use should be from the "Access" group, not the "Watch" group). Antibiotic use was high in Ethiopian tertiary hospitals, with most patients receiving antibiotics, mainly from the WHO "Watch" group, contrary to guidelines. Three classes (cephalosporins, imidazoles, and glycopeptides) made up the majority of prescriptions, mostly for hospital-acquired infections. Urgent interventions and strengthened antimicrobial stewardship are needed to address inappropriate use and combat resistance.

BackgroundAntibiotics are among the most used medicines globally, but antimicrobial resistance (AMR) threatens their effectiveness. The greatest mortality burden associated with AMR is in sub-Saharan Africa. However, antimicrobial prescribing practice and stewardship remain challenges in the African regions. Thus, this study aimed to evaluate and compare antibiotic utilization patterns in tertiary hospitals in Ethiopia during 2022.MethodA retrospective cross-sectional study was conducted in adult wards of five public tertiary care hospitals in Ethiopia with a total of 3,283 beds. Data were retrieved from 807 randomly selected patient records using the online Kobo tool. Analysis utilized the World Health Organization (WHO) Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) (ATC/DDD) method. The result was presented using tables, charts, and text.ResultsA total of 2,718 drugs were prescribed to 807 patients with an average of 3.4 drugs per patient (range 1–7) during a total of 8638 bed-days. Of the total drugs prescribed, antibiotics account for 1,035 (38%), with an average of 1.3 (1,035/807) antibiotics per patient. Five hundred fifty-six (69%) patients were prescribed at least one antibiotic. The overall antibiotic consumption was 108 DDD/100 bed-days, 37.5/100 bed-days for hospital-acquired infections, and 32.8/100 bed-days for community-acquired infections. The rest were for prophylaxis purposes. The majority of antibiotics were prescribed in medical and surgical wards; 34.9/100 and 27.5/100 bed-days, respectively. The most prescribed antibiotics were ceftriaxone, metronidazole, and ceftazidime. Overall, the AWaRe “Watch” group antibiotics use occurred in 74% (73 DDD/100 bed-days) of total antibiotic consumption, which was higher than the WHO recommendation (at least 60% of total antibiotic use should be from the “Access” group, not the “Watch” group).ConclusionAntibiotic use was high in Ethiopian tertiary hospitals, with most patients receiving antibiotics, mainly from the WHO “Watch” group, contrary to guidelines. Three classes (cephalosporins, imidazoles, and glycopeptides) made up the majority of prescriptions, mostly for hospital-acquired infections. Urgent interventions and strengthened antimicrobial stewardship are needed to address inappropriate use and combat resistance.

Perceptions of antibiotic stewardship programmes and determinants of antibiotic prescribing patterns among physicians in tertiary hospitals in Bangladesh: implications for future policy and practice