A multicentre point prevalence survey of patterns and quality of antibiotic prescribing in Indonesian hospitals

Abstract

Background The global emergence of antimicrobial resistance is driven by antibiotic misuse and overuse. However, systematic data in Indonesian hospitals to adequately inform policy are scarce. Objectives To evaluate patterns and quality indicators of antibiotic prescribing in six general hospitals in Jakarta, Indonesia. Methods We conducted a hospital-wide point prevalence survey (PPS) between March and August 2019, using Global-PPS and WHO-PPS protocols. The analysis focused on antibacterials (antibiotics) for systemic use. Results Of 1602 inpatients, 993 (62.0%) received ≥1 antimicrobial. Of 1666 antimicrobial prescriptions, 1273 (76.4%) were antibiotics. Indications comprised community-acquired infections (42.6%), surgical prophylaxis (22.6%), hospital-acquired infections (18.5%), medical prophylaxis (9.6%), unknown (4.6%) and other (2.1%). The most common reasons for antibiotic prescribing were pneumonia (27.7%), skin and soft tissue infections (8.3%), and gastrointestinal prophylaxis (7.9%). The most prescribed antibiotic classes were third-generation cephalosporins (44.3%), fluoroquinolones (13.5%), carbapenems (7.4%), and penicillins with β-lactamase inhibitor (6.8%). According to the WHO AWaRe classification, Watch antibiotics accounted for 67.4%, followed by 28.0% Access and 2.4% Reserve. Hospital antibiotic guidelines were not available for 28.1% of prescriptions, and, where available, guideline compliance was 52.2%. Reason for the antibiotic prescription, stop/review date and planned duration were poorly documented. Culture-guided prescriptions comprised 8.1% of community-acquired infections and 26.8% of hospital-acquired infections. Conclusions Our data indicate a high rate of empirical use of broad-spectrum antibiotics in Indonesian hospitals, coupled with poor documentation and guideline adherence. The findings suggest important areas for antimicrobial stewardship interventions.

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

“…Use of parenteral antibiotics was very high (88%) compared to oral (12%) in the present study. These values are similar to the use of parenteral antibiotics in Indonesia (85.1%) and Pakistan (91.5%) [ 46 , 47 ]. The overuse of parenteral antibiotics (specifically, using parenteral antibiotics when not indicated or for longer than indicated) often increases costs of care, including costs associated with antibiotics, and nursing time and also increasing the duration of hospital stays; as such, overuse poses a challenge for infection prevention and control, especially in resource-constrained countries, such as Uganda.…”

Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia

“…Lack of confidence in prescribing decisions and defensive prescribing were common due to diagnostic uncertainty, fear of patient deterioration or complications, or because patients or their relatives insisted. The study findings expand on our recently published paper on the patterns and quality indicators of antibiotic prescribing in the same hospitals, which identified several priority areas for stewardship 17 .…”

“…We conducted a cross-sectional survey between March and August 2019 among all antimicrobial prescribing physicians at six public and private general hospitals in Jakarta, Indonesia, as part of a mixed-method study to identify targets for quality improvement in antibiotic prescribing practices (EXPLAIN study 17 ). The hospitals included two tertiary-care government hospitals and four secondary hospitals, three of which were private hospitals.…”

Impact of an Anti-Microbial Stewardship Program on Targeted Antimicrobial Therapy in a Tertiary Care Health Care Institute in Central India

“…The overall bacterial culture rate (BCR) in our study is 58.3%. BCR in different studies is within 15% to 70.5% in various countries as can be seen in Table 3 [11][12][13][14][15][16][17][18][19][20].…”