Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital

Abstract

Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients’ notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.

The feasibility and generalizability of assessing the appropriateness of antimicrobial prescribing in hospitals: a review of the Australian National Antimicrobial Prescribing Survey

“…Concordance of prescribing with guidelines and appropriateness of antimicrobial prescribing were similar between the two hospitals, at approximately 60%. 49 Based on the results, key areas to target AMS interventions were the medical department in UMMC and surgical department in UKMC.…”

“…Overall, the compliance with prescribing guidelines was 48.1%, and 58.2% of prescriptions were assessed as appropriate (the difference between the two being prescriptions that varied from guidelines for documented clinically justifiable reasons). 49 The most common reasons for inappropriate antimicrobial use were the unnecessary use of broad-spectrum antimicrobials and the lack of a documented indication for antimicrobial use. A focus group was undertaken, using the nominal group technique.…”

“…A frequent source of inappropriate use was surgical antibiotic prophylaxis. 49 In response to these findings, the surgical teams requested a surgical prophylaxis prescribing care bundle, consisting of extra resources, a prescribing checklist as well as regular audits with prescriber feedback. The MAC also approved an automatic stop order for surgical prophylaxis after 24 h.…”

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

“… 21 Many of the existing NAPS appropriateness metrics were deemed to have moderate to high feasibility for routine collection, and this information will guide the design of a dedicated module. 21 Similarly, the Hospital NAPS has been used in several international settings, including Canada, New Zealand, the United Kingdom, Bhutan, Malaysia 22 and Fiji, and feedback from the clinical leaders at these sites has been collected via surveys and key informant interviews to iteratively improve the tool to meet needs.…”

Antimicrobial Prescribing Confidence and Knowledge Regarding Drug Resistance: Perception of Medical Students in Malaysia and the Implications

“…The growing awareness of the clinical and economic costs of AMR have resulted in global and national action plans to reduce AMR coordinated by the WHO and others [16,[20][21][22]. This includes Malaysia, which has growing AMR rates and concerns with appropriate antimicrobial prescribing across sectors [20,[23][24][25][26][27][28] Improving medical students' knowledge regarding antibiotics and AMR are essential to enhance appropriate antimicrobial prescribing following graduation, achieved through ASPs and other programs [29][30][31][32]. A comprehensive understanding of the pathophysiology of diseases as well as clinical pharmacology and therapeutics, are also indispensable to improve their prescribing practices post-qualification along with quality targets [33][34][35][36].…”