Infection Control & Hospital Epidemiology (2019), 40, 224–227 doi:10.1017/ice.2018.321
Concise Communication
Point-prevalence study of antimicrobial use in public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices
Tianchen Sheng MSc1, Gaya B. Wijayaratne MBBS, MD2,3, Thushani M. Dabrera MBBS, MD4, Richard J. Drew PharmD5, Ajith Nagahawatte MBBS, MD2,3, Champica K. Bodinayake MBBS, MD2,3, Ruvini Kurukulasooriya MSc3, Truls Østbye MD, PhD1,3,5, Kristin J. Nagaro MD5, Cherin De Silva MBBS3, Hasini Ranawakaarachchi MBBS3, A. T. Sudarshana MBBS4, Deverick J. Anderson MD, MHS5, Christopher W. Woods MD, MPH1,3,5
and L. Gayani Tillekeratne MD, MSc1,3,5 1Duke Global Health Institute, Durham, North Carolina, 2Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka, 3Duke-Ruhuna Collaborative Research Centre, Galle, Sri Lanka, 4Sri Lanka Ministry of Health, Colombo, Sri Lanka and 5Duke University School of Medicine, Durham, North Carolina
Abstract
A point-prevalence study of antimicrobial use among inpatients at 5 public hospitals in Sri Lanka revealed that 54.6% were receiving antimicrobials: 43.1% in medical wards, 68.0% in surgical wards, and 97.6% in intensive care wards. Amoxicillin-clavulanate was most commonly used for major indications. Among patients receiving antimicrobials, 31.0% received potentially inappropriate therapy.
(Received 27 July 2018; accepted 20 October 2018; electronically published 7 December 2018)
Antimicrobial resistance is a global public health crisis and is largely driven by antimicrobial use.1 In the United States, up to 30% of antimicrobials used in hospitals are unnecessary or are prescribed incorrectly. In low- or middle-income countries (LMICs), antimicrobial overuse appears to be greater.2 Point- prevalence surveys offer an initial feasible step for describing antimicrobial use and identifying targets to reduce inappropriate use.1,3 The objective of this study was to use point-prevalence surveys to identify the prevalence, patterns, and indications of antimicrobial use among patients admitted to public hospitals in the Southern Province, Sri Lanka.
Materials and Methods Study design and setting
A point-prevalence study of antimicrobial use was conducted using single-day cross-sectional surveys among inpatients at 5 public hospitals in the Southern Province, Sri Lanka, from June 14, 2017, to August 10, 2017. Surveys were conducted at 1 tertiary-care hospital (1,745 beds), 1 secondary-care hospital (365
Author for correspondence: L. Gayani Tillekeratne, 310 Trent Drive, Durham, NC
27710. E-mail:
gayani.tillekeratne@duke.edu PREVIOUS PRESENTATION: These data were presented at a poster session at the
American Society for Microbiology Microbe 2018 conference on June 7–11, 2018, in Atlanta, Georgia.
Cite this article: Sheng T, et al. (2019). Point-prevalence study of antimicrobial use in
public hospitals in southern Sri Lanka identifies opportunities for improving prescribing practices. Infection Control & Hospital Epidemiology 2019, 40, 224–227. doi: 10.1017/ ice.2018.321
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
beds), and 3 primary-care hospitals (26 beds, 60 beds, and 104 beds).4
Study population and data collection
Trained research assistants visited the prespecified wards at 8:00 A.M. on survey days. All patients hospitalized on the ward at the time of survey were included. Patient medical records were used to collect sociodemographic information and clinical data including antimicrobials prescribed at the time of survey.5 Anti- biotics, antifungals, and antivirals prescribed via the intravenous or oral route were recorded. On average, a research assistant spent 10–15 minutes reviewing each patient chart. The Ruhuna University Ethical Review Committee and the
Duke University Institutional Review Board approved this study. The directors of each hospital and the Regional Director of Health Services, Galle, Sri Lanka also approved this study.
Data analysis
Data were entered into a Research Electronic Data Capture (REDCap) database and statistical analyses were performed using R version 3.4.1 software (R Foundation for Statistical Computing, Vienna, Austria). Overall prevalence of antimicrobial use was defined as the number of patients receiving ≥1 antimicrobial agent at the time of survey divided by the total number of patients. Demographic and clinical characteristics associated with antimicrobial use were assessed using the χ2 and Kruskall-Wallis tests. Potentially inappropriate antimicrobial use was defined as (1) antimicrobial use discordant with the Sri Lanka College of
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