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Compliance with global action plan on antibiotic prescription and utilization: a multi-facility cross-sectional study in southern Nigeria
Authors: Mary Richard Akpan
Abstract
Background: Antibiotic resistance is a growing concern worldwide. The World Health Organization (WHO) developed the AWaRe classification to categorize antibiotics based on their risk of resistance and to guide appropriate antibiotic prescribing. Understanding the pattern of antibiotics prescribing can help to inform policy and practice.
Objective: To assess the extent of compliance with global action plan on antibiotic prescription and utilization in the country by assessing antibiotic prescribing patterns in selected public healthcare facilities using the WHO AWaRe classification of antibiotics.
Method: A cross sectional study involving a 3-month review of antibiotic prescription pattern using the WHO AWaRe classification of antibiotics was carried out in 5 selected healthcare facilities in Akwa Ibom State, southern Nigeria, between September 01 and November 30, 2023.
Results: A total of 2,230 antibiotic prescriptions were reviewed across the 5 selected hospitals during the period of the study. The proportion of antibiotics prescribed within the Acess group of the AWaRe classification in the hospitals was 48.7% (n = 1,086), while the proportion of antibiotics prescribed within the “Watch” group was 51.3% (n = 1,144). No antibiotic was prescribed within the Reserve group across the hospitals within the period of the study.
Conclusion: There’s a lack of compliance with the WHO global action plan on antibiotic prescription and utilization as the overall prescribing of Access group antibiotics in this study falls short of the WHO recommendations. There is a need for a review of the nationwide strategy to optimize the use of antibiotics in the country.”
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Evaluation of vancomycin utilization in medical and pediatric wards: a retrospective cross-sectional study at Bule Hora University Teaching Hospital, Ethiopia
Authors:Aliyi Gerina
Abstract
Background: Vancomycin is a critical antibiotic used for serious Gram‑positive infections, particularly methicillin‑resistant Staphylococcus aureus (MRSA). However, inappropriate use contributes to antimicrobial resistance (AMR). Limited evidence exists on the extent and appropriateness of vancomycin utilization in Ethiopian hospitals.
Objectives : To evaluate the prescribing pattern and appropriateness of vancomycin use in medical and pediatric wards at Bule Hora University Teaching Hospital (BHUTH).
Methods: A retrospective cross‑sectional study was conducted among 182 patient medical records reviewed. Data were extracted using a structured checklist adapted from the Ethiopian Standard Treatment Guidelines (STG). Patient sociodemographic characteristics, clinical profiles, vancomycin prescribing pattern, appropriateness, and outcomes were assessed. Data were analyzed using the Statistical Package for the Social Sciences version 27. Descriptive statistics were employed and results presented in tables and figures.
Results: Of 182 patients admitted, 81 (44.8%) received vancomycin, mainly for pyogenic meningitis (78.9%) and severe community‑acquired pneumonia (13.3%). Prescribing appropriateness was 84.6% for indication, 96.3% for dose, and 98.7% for frequency, but lower for duration (71.6%). All prescriptions were empirical, with no microbiological confirmation. Ceftriaxone was the most frequent co‑prescribed drug (42.0%). Among vancomycin recipients, 74.1% improved, 11.1% died, and no adverse drug reactions were documented.
Conclusion: Vancomycin utilization at BHUTH demonstrated generally appropriate indication, dosing and frequency, but all prescriptions were empirical, without microbiological confirmation, and nearly one‑third had inappropriate treatment duration. These practices increase the risk of antimicrobial resistance, especially given vancomycin’s WHO AWaRe classification as a Watch antibiotic.
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Microbiological profile of sterile site organisms and culture positivity rates from a decade of paediatric admissions at a tertiary hospital in South Africa: A lower and middle-income country perspective
Authors: Prenika Jaglal
Abstract
Background: Sterile site (SS (blood and cerebrospinal fluid)) infections are formidable causes of childhood morbidity and fatality. This study aimed to determine aetiological organisms, antimicrobial resistance patterns and sepsis trend rates in paediatric inpatients from a low-and middle-income country.
Methods: A retrospective review of SS culture results of inpatients from the neonatal unit (NNU), general paediatric (GPW) and paediatric haematology-oncology wards (PHOW) at Chris Hani Baragwanath Academic Hospital, South Africa, from January 2013 to December 2022.
Results: A total of 58 053 SS specimens were submitted for analysis. Culture-positivity rate was 36.0 %, comprising 22.8 % and 13.2 % for pathogens and contaminants. Pathogen culture-positivity rate was higher in the NNU when compared to GPW (35.5 % vs 17.6 %; OR–5.38; 95 % CI 4.99–5.81) but lower than PHOW (35.5 % vs 46.6 %; OR-0.47; 95 % CI 0.39–0.52). Infection rates per 1000 patient-days increased from 1.74 in 2013 to 3.11 in 2022. Gram-negative bacteria (GNB) (66.0 % vs 18.7 %, OR-5.70; 95 % CI 5.23–6.19) and yeast (12.4 % vs 8.4 %, OR-7.66; 95 % CI 6.13–9.57) were more common in NNU than GPW. Multidrug-resistant (MDR) pathogen prevalence was 35.1 % with extended-spectrum beta-lactamase Enterobacterales contributing 40–50 %. Carbapenem-resistant Acinetobacter species increased from 40 % to 60 % from 2013 to 2022 (p = 0.004). MRSA prevalence decreased from 30 % to 10 % from 2013 to 2022 (p = 0.004).
Conclusion: The burden of paediatric MDR gram-negative SS infection was relatively high requiring ongoing surveillance, judicious antimicrobial use, while reinforcing infection control contact-based transmission precautions. Further studies on drivers of antimicrobial resistance such as unit specific antimicrobial consumption rates and prescriber practices, should be explored.”
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Trends and relationship between antibiotic consumption and carbapenem-resistant Gram-negative bacteria at a tertiary hospital in shaanxi, China from 2011 to 2023
Authors: Hai yue Bai
Abstract
Background: Carbapenem-resistant infections are increasing, posing a serious public health threat. This study investigates the relationship between carbapenem-resistant Gram-negative (CRGN) organisms and antimicrobial consumption in a tertiary hospital from 2011 to 2023, particularly focusing on carbapenem consumption.
Methods: A retrospective analysis was conducted on quarterly data from 2011 to 2023 at the First Affiliated Hospital of Xi’an Jiaotong University (FAHXJU), covering antibiotic consumption and the incidence rates of carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Enterobacter coli (CREC), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Antibiotics consumption was expressed as the number of defined daily doses/1000 patient-days (DDDs/1000 PDs). Trends and correlations assessed by regression and Spearman tests.
Results: First, the total antibiotics consumption remained stable (β = 0.039, P ≥ 0.05). However, the consumption of carbapenems significantly increased (P < 0.05), from the lowest 7.91 to the highest 57.96 DDDs/1000 PDs. Second, the resistance rates of CRKP (β = 0.364) and CREC (β = 0.035) showed an upward trend (P < 0.05). While the resistance rates of CRAB (β = −0.096, P ≥ 0.05) and CRPA (β = −0.078, P ≥ 0.05) remained stable, a positive correlation was found between carbapenem use and resistance rates of CRKP and CREC (P < 0.05).
Conclusion: Despite stable overall antibiotic use, carbapenem consumption has increased substantially and is significantly correlated with the rising resistance of CRKP and CREC. Targeted antimicrobial stewardship and empirical therapy optimization are urgently needed, with future multicenter studies are required to validate these findings.”