Infection Control & Hospital Epidemiology
inappropriate (Table 1).6 In addition, 160 patients (17.1%) were receiving potentially redundant therapy (Supplemental Table 2). Overall, 290 (31.0%) of patients were receiving poten- tially inappropriate antimicrobial therapy that was either guide- line discordant or redundant.
Discussion
Antimicrobial resistance is a growing global problem. Anti- microbial point-prevalence surveys are a feasible initial step in evaluating antimicrobial use and identifying targets for improvement.1,2,7 We report the first point-prevalence study of antimicrobial use in public hospitals in Sri Lanka. In our study, prevalence of antimicrobial use was ~50%,
similar to figures reported from other Asian and LMIC set- tings.9,10 We discovered that antimicrobial use was highest in surgical wards and intensive care units, perhaps due to greater acuity. Unnecessary and inappropriate broad-spectrum anti- microbial use needs to be identified and addressed in future studies.
Among patients receiving antimicrobial therapy, nearly 40%
did not have a clear indication documented in the medical chart, and another 15% did not have an indication that was documented or could be inferred. Prior studies have shown that documenting an indication for antimicrobials reduces inappropriate therapy, and this action may be a target for future antimicrobial stew- ardship efforts.10 Nearly one-third of patients were receiving either guideline- discordant or redundant therapy. This estimate may be con- servative because we did not account for dosing and duration in our assessments. In addition, upper respiratory infection, which is usually viral in etiology, was the fifth most common indication for antimicrobial use. We could not assess whether antimicrobials were warranted for the specific upper respiratory infections in this study. Finally, ~10% of patients were receiving carbapenem therapy, and this class was among the most commonly used for lower respiratory infection, urinary tract infection, and surgical prophylaxis. The need for broad-spectrum therapy with carba- penems is another area for future study. Our study was limited by the use of medical charts, which may
contain incomplete information, especially for patients admitted on the day of survey. Potentially redundant combinations of antimicrobials were identified based on spectrum of activity, and combination use may have been warranted in some patients. Finally, we only considered primary therapy as listed in the guidelines as appropriate, and some patients may have been receiving alternate or other therapy appropriately. In conclusion, a point-prevalence study was feasible and
effective at identifying potentially inappropriate antimicrobial use in southern Sri Lanka. Opportunities for improving antimicrobial
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use were identified and should be addressed by future anti- microbial stewardship efforts.
Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.321
Acknowledgments.
Financial support. This study was funded by a fieldwork grant from the Duke Global Health Institute to T Sheng. LG Tillekeratne was supported by supported by the National Institutes of Allergy and Infectious Diseases (grant no. K23AI125677). The authors also acknowledge the Duke Global Health Institute and the Hubert-Yeargan Center for Global Health for providing operational funds for the study site, the Duke-Ruhuna Collaborative Research Centre.
Conflicts of interest. All authors report no conflicts of interest relevant to this article
References
1. Laxminarayan R, Duse A, Wattal C, et al. Antibiotic resistance—the need for global solutions. Lancet Infect Dis 2013;13:1057–1098.
2. Centers for Disease Control and Prevention. Antibiotic use in the United States, 2017: progress and opportunities. Atlanta, GA: US Department of Health and Human Services, CDC; 2017.
3. Centers for Disease Control and Prevention. The core elements of human antibiotic stewardship programs in resource-limited settings: national and hospital levels. Centers for Disease Control and Prevention website.
https://www.cdc.gov/antibiotic-use/healthcare/ implementation.html. Published 2018. Accessed November 21, 2018.
4. Ministry of Healthcare and Nutrition, Sri Lanka. Health information unit beds and institution annual census Sri Lanka. Sri Lanka: Medical Statistics Unit, Ministry of Health, Nutrition and Indigenous Medicine; 2012.
5. Magill SS, Edwards JR, Beldavs ZG, et al. Prevalence of antimicrobial use in US acute care hospitals, May–September 2011. JAMA. 2014;312:1438–1446. doi:10.1001/jama.2014.12923
6. Sri Lanka College of Microbiologists in Collaboration with other Professional Colleges in Healthcare and The Ministry of Health, Nutrition and Indigenous Medicine. Empirical and prophylactic use of antimicrobials, national guidelines, 2016. Sri Lanka College of Microbiologists website.
http://slmicrobiology.net/download/National- Antibiotic-Guidelines-2016-Web.pdf. Published 2016. Accessed Novem- ber 21, 2018.
7. Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis 2011;11:692–701.
8. Xie DS, Xiang LL, Li R, Hu Q, Luo QQ, Xiong W. A multicenter point- prevalence survey of antibiotic use in 13 Chinese hospitals. J Infect Public Health 2015;8:55–61.
9. Thu TA, Rahman M, Coffin S, Rashid HO, Sakamoto J, Nguyen VH. Antibiotic use in Vietnamese hospitals: a multicenter point- prevalence study. Am J Infect Control 2012;40:840–844.
10. Yeo JM. Antimicrobial stewardship: improving antibiotic prescribing practice in a respiratory ward. BMJ Open Quality 2016;5:u206491.w3570. doi: 10.1136/bmjquality.u206491.w3570.
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