Point prevalence survey on antimicrobial use in a tertiary private hospital in Malaysia

Abstract

Background: The threat of antimicrobial resistance in healthcare settings is globally recognized. To design and implement effective antimicrobial stewardship (AMS) interventions, data regarding current antimicrobial prescribing patterns is pivotal. As such, this point prevalence survey aims to determine the baseline antimicrobial prescribing patterns at Sunway Medical Centre (SunMed), with the intention to formulate strategies for appropriate antimicrobial use through AMS programmes. Methods and materials: A consecutive 3-day cross-sectional survey was conducted in June 2019 using a convenient sampling method. The survey included all hospitalized patients of all ages from 17 non-critical care wards (total 416 beds) who were still receiving at least one oral or injectable antimicrobial at the time of the survey. Patients who were activated for discharge prior to the time of the survey and patients who admitted in daycare units and critical care units were excluded from the survey. Data was collected using a survey form modified from Global Point Prevalence Survey (PPS) tool designed by University of Antwerp, Belgium. Results: Out of 332 patients surveyed, 162 (49%) patients were on antimicrobials. 126 (78%) patients were on 1 antimicrobial while 36 (22%) patients were on multiple antimicrobials. A total of 69 (43%) patients had culture & sensitivity (C&S) taken prior to antimicrobials administration. Of 200 prescribed antimicrobials, 184 (92%) were used empirically (62.5% medical cases and 29.5% surgical cases), while 16 (8%) were targeted therapy. Cephalosporin, beta-lactam-beta-lactamase inhibitor combinations and macrolide were the top 3 antimicrobial class prescribed (39%, 30%, 12% respectively). The antimicrobials were prescribed for community-acquired infections (54%), followed by surgical prophylaxis (33%), internal healthcare-associated infection (HAI) (7.5%), external HAI (5%) and medical prophylaxis (0.5%). The three most common anatomical sites related infection treated with antimicrobials were pneumonia and respiratory tract infections (16%), bone/joint related surgical prophylaxis (13.8%) and gastrointestinal infections (13.8%). 11 (5.5%) antimicrobials prescribed were categorized as others while 2 (1%) were completely unknown indication. Conclusion: Our analysis indicated that the use of antimicrobials was high in SunMed, mainly empirically. There is a need to explore factors contributing to this and develop strategies for appropriate antimicrobial use through AMS programmes.