(102) A Point Prevalence Study of The Use of Antibiotics at Six Tertiary Care Hospitals in The Kathmandu Valley, Nepal

Publication Number: 1147

Background: Antimicrobial resistance (AMR) is a significant global health problem and a major threat to global public health. Point prevalence survey (PPS) on antibiotic use developed by WHO has already been used in many hospitals around the world.

Objectives: This study was done with an objective of collecting information on the prescribing of antibiotics using PPS methodology in six different private hospitals in Nepal.

Methods: This was a cross sectional descriptive study done from 20th July to 28th July 2021 among inpatients admitted at or before 8:00AM on the day of survey in various wards of the hospital. Patients of both gender and all age groups were included. Patient sampling was done as per the PPS methodology. The institutional capacity to promote appropriate antimicrobial use, was measured by the indicators for infrastructure, policy and practice and monitoring and feedback at each study site. Data analysis was presented as frequencies and percentages.

Results: Patients above 60 years were 34 (18.7%). There were equal number of males and females, 91 (50%). Maximum patients were from the surgery ward 38 (20.8%) followed by Obstetrics and Gynecology and Plastic Surgery wards 25 (13.5%) each.
Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of antibiotic prophylactic use was one day in 66 (63.7%) patients. Culture was done for 67 samples. Blood, urine, sputum, and wound swabs were the common samples. The culture result was positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Cephalosporins, 71 (38.6%) were the commonest group of antibiotics, followed by fluroquinolones, 28 (15.3%).
Drug and therapeutics and infection control committees, and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services in all hospitals. Antibiotic formulary and antibiotic guideline was present in 4/6 sites, and facilities audited or reviewed surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use was present in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) sites.

Conclusions: Not all parameters for infrastructure, policy and practice and monitoring and feedback were present in the study sites. PPS studies should be done periodically to study AMR and monitor the impact of antimicrobial stewardship and infection control programs.

Keywords: Point prevalence survey, antibiotics, private hospitals, tertiary care centers, Nepal