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| ORIGINAL ARTICLE |
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| Year : 2017 | Volume
: 8
| Issue : 1 | Page : 42-46 |
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A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals
OO Oduyebo1, AT Olayinka2, KC Iregbu3, A Versporten4, H Goossens4, PI Nwajiobi-Princewill3, O Jimoh2, TO Ige2, AI Aigbe3, OI Ola-Bello1, AO Aboderin5, FT Ogunsola1
1 Department of Medical Microbiology, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Medical Microbiology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Department of Medical Microbiology, College of Health Sciences, University of Abuja/National Hospital, Abuja, Nigeria
4 Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
5 Department of Medical, Microbiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| Date of Web Publication | 30-Jan-2018 |
Correspondence Address:
O O Oduyebo
Department of Medical Microbiology, Lagos University Teaching Hospital, Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | 28 |
DOI: 10.4103/atp.atp_38_17
Introduction: Antimicrobial resistance has become a global challenge in health care. Its emergence in previously sensitive bacteria is usually associated with poor antibiotic-prescribing patterns. Methodology: A point prevalence survey was carried out in four tertiary hospitals in Nigeria in 2015 to determine the rate and characteristics of antibiotic prescription. Results: Of 828 patients eligible for the study, 69.7% received antibiotics, with highest rates in the adult Intensive Care Unit. There were therapeutic indications in 51.2% of the prescriptions, of which 89.5% were for community-acquired infections. Third-generation cephalosporins were the most prescribed antibiotics. On the evaluation of surgical prophylaxis, only 4.1% were compliant with institutional guidelines and 39.2% gave a reason for prescribing in patient case notes. Less than 1% of the prescriptions were based on the use of biomarkers. Conclusion: The prevalence of antibiotic prescription in Nigerian hospitals is high with only about 50% of prescriptions based on clear therapeutic indications. We provide evidence that the country needs to institute a cohesive antimicrobial stewardship intervention program. Keywords: Antimicrobial stewardship, Nigeria, point prevalence, surveillance
How to cite this article:
Oduyebo O O, Olayinka A T, Iregbu K C, Versporten A, Goossens H, Nwajiobi-Princewill P I, Jimoh O, Ige T O, Aigbe A I, Ola-Bello O I, Aboderin A O, Ogunsola F T. A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals. Ann Trop Pathol 2017;8:42-6 |
How to cite this URL:
Oduyebo O O, Olayinka A T, Iregbu K C, Versporten A, Goossens H, Nwajiobi-Princewill P I, Jimoh O, Ige T O, Aigbe A I, Ola-Bello O I, Aboderin A O, Ogunsola F T. A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals. Ann Trop Pathol [serial online] 2017 [cited 2023 Dec 2];8:42-6. Available from: https://www.atpjournal.org/text.asp?2017/8/1/42/224161 |
| Introduction | |  |
Antimicrobial resistance (AMR) is currently of global significance, with increasing number of microorganisms exhibiting resistance to available antimicrobial agents.[1],[2],[3],[4] It involves both the Gram-positive and Gram-negative bacteria, with global prevalence rates as high as 60% or more.[5],[6],[7],[8],[9],[10] This resistance is particularly higher in hospital-acquired strains.[11]
To combat this rise in AMR, the World Health Organization (WHO) advocates the adoption of antimicrobial stewardship by health-care providers to check and reduce the burden of antibiotic resistance.[12],[13] This strategy involves the application of objective interventions to influence prescribing practices, thereby promoting rationale and appropriate antimicrobial use.[14],[15]
This intervention is vital in the developing countries which usually have a combination of poor antimicrobial-prescribing practices, unregulated over-the-counter sale of antibiotics, and increasing rates of AMR.[16],[17],[18],[19],[20],[21],[22] However, before any antimicrobial stewardship program can be implemented, antimicrobial prescribing information is required; this information is currently scanty in Nigeria.[16],[23],[24],[25] To obtain objective and reproducible information on antimicrobial prescription, a uniform and standardized method of data collection needs to be applied. Point prevalence survey (PPS) has been a popular and widely accepted method for over 20 years [26],[27],[28],[29] because it is less expensive, less time-consuming, and easier to conduct than incidence studies [28],[30] and can be used to identify and assess quality indicators [31],[32],[33] to evaluate problems of antibiotic use and resolve prescribing issues.
To acquire baseline information on antimicrobial-prescribing practices in Nigeria, four tertiary hospitals were assessed on antimicrobial prescribing practices in the north-central, northwest, and southwest regions of the country using uniform and standardized PPS methods.
| Methods | | |
This survey was carried out across all wards of the Ahmadu Bello University Teaching Hospital, Zaria, Lagos University Teaching Hospital, Lagos, National Hospital, Abuja, and the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife.
From April to June 2015, a PPS was conducted across all clinical departments of the participating hospitals by teams of clinical microbiologists. Data were collected in each center within 2 weeks.
All hospitalized patients receiving at least an antimicrobial agent on the day of PPS were included. Eligibility criteria required that patients would have been admitted to the ward at least 24 h before the survey and still be present at 8 am on the day of the survey. In addition, for surgical patients, the dosage and time of administration of prophylactic antimicrobials before or at surgery were obtained to determine the duration and frequency of prophylaxis.
The total number of patients in each ward was used as the denominator. The survey for all beds in each ward had to be completed in a single day. For each patient treated with systemic antimicrobials, information was collected using a standardized form on age, sex, antimicrobial agents, number of doses per day, route of administration, indications for treatment, whether the indication was actually documented in notes, microbiological data, compliance with prescribing information/guidelines, and documentation of stop/review date of prescription.
Definitions and rates used in this study
- Therapy: "The use of one antibiotic using one route of administration"
- Antimicrobial prevalence (%) was calculated as the "number of treated patients/number of registered patients × 100.
From the data collected, quality indicators were calculated as follows:
- For percentage of patients with reason for antibiotic use in notes and stop/review date documented: Reason in notes and stop/review date documented for each antibiotic level over total scores for this indicator
- For % guideline compliance: Guideline compliance was counted at each patient level over total scores for this indicator. Guideline compliance was counted at each patient level and diagnosis for compliance and recorded as yes or no only.
- For combination therapy with more than one antibiotic: If one antibiotic by diagnosis is not compliant, then this combination therapy as a whole for this diagnosis was counted as noncompliant.
| Results | | |
The survey included 828 inpatients on 72 wards, of which 577 (69.7%) received at least one antimicrobial on the day of the point prevalence study.
The highest prevalence for antimicrobial use was in the adult Intensive Care Units (ICUs) (88.9%), followed by pediatric medical wards (84.6%) and neonatal ICU (76.7%) [Figure 1]."
Of 523 therapeutic antibiotic prescriptions, 89.5% were issued for community-acquired infections while 397 (38.8%) prescriptions were issued for prophylaxis, of which 277 (69.9%) were issued for surgical prophylaxis [Table 1].
Third-generation cephalosporins constituted 21.4% of the prescriptions for therapeutic use mainly ceftriaxone (18.9%), followed by metronidazole (18.0%) and quinolones (14.1%); especially ciprofloxacin (9.9%). Ceftriaxone was the most common antibiotic in both surgical (28.0%) and medical (13.0%) prophylaxis [Table 2]. | Table 2: Top 5 most prescribed antibiotics for therapeutic and prophylactic uses
Click here to view |
Prescriptions for surgical prophylaxis were given for >1 day in 95.0% of cases [Table 3]. Parenteral antibiotics were prescribed in 74.8% of the time. Indication for antibiotic prescription was documented in 61.8% of cases, and a stop or review date was documented for 27.8% of the prescriptions. Compliance with local antibiotic guidelines was 7.1% for medical and 4.1% for surgical indications. A biomarker result was utilized in 0.5% of all antibiotic prescriptions, of which C-reactive protein was used in 80% of those cases.
| Discussion | | |
Antimicrobial-prescribing surveillance aids in identifying problematic areas for intervention, accessing the success of such interventions, and planning future interventions.[34],[35],[36],[37] This PPS for the collection of antimicrobial data is, to our knowledge, the first of its kind in Nigeria.
Majority (69.7%) of patients were found to have had at least a single antimicrobial exposure. This value, though much higher than the worldwide average of 34.7%,[38] obtained from similar PPS, is within the established range in Africa.[4],[39],[40],[41] It compares poorly with the lower rates in the European Union (EU) and the US.[27],[42] This may be related to the poor use of diagnostic tools in guiding antimicrobial prescriptions with the associated high level of unguided therapy in Africa compared with Europe and the US, as well as the general lack of antimicrobial stewardship.[18],[43] This poor use of the laboratory to guide therapy has been recorded across Africa and is a reflection of the weak laboratory infrastructure as well as inadequate human capacity in its laboratories.[44]
Adult ICU wards had the highest rates of antimicrobial prescriptions, similar to reports from other studies.[27],[42],[45] However, the observed rate of 88.9% in this study was higher than the 29%, 34%, 59.3%, and 60.6% in Europe,[27] Canada,[27] US,[46] and Turkey, respectively,[45] A WHO fact sheet publication shows that the frequency of acquisition of infection in the ICU in low- and middle-income countries is at least 2-3 folds higher than in high-income countries.[47] This combined with the higher level of general local immunosuppression as well as other comorbidities in ICU patients may account for the higher rate antimicrobial prescription.[48],[49] The rates in the pediatric and neonatal units were the next highest. Similar high rates were reported in Egypt [40] and Ethiopia [50] though some other studies reported lower rates.[29],[51]
The picture of poor-prescribing practice is further reinforced by the dominance of broad-spectrum antimicrobials, particularly cephalosporins. Other studies from Egypt, Turkey, and the EU show similar cephalosporin usage rates.[28],[40],[45] This prescription pattern, which is associated with the tendency to use broad-spectrum antibiotics, is usually due to poor or absent diagnostic tools or failure to utilize them properly where available.[22] Unfortunately, the broad spectrum of actions of these drugs contributes to the emergence of AMR.[40] This is compounded by the rate of quinolones usage, which was among the most commonly prescribed systemic antimicrobials. Excessive quinolone has been shown to promote AMR [52] and is a reflection of poor antimicrobial stewardship.[27] The high level (74.8%) of the use of intravenous route of administration is likely related to the high cephalosporin use which is mainly intravenous. However, there was a high rate of parenteral antimicrobial use across all hospital and wards, reflecting the earlier stated poor use of laboratories to guide therapy.[18],[22],[43] The high dependency nature of ICU patients combined with the predominance of prescriptions from ICUs would certainly enhance high parenteral administration as seen in this study.
The extended duration of surgical prophylaxis which was >24 hours in most of the cases, was contrary to accepted international best practices. This further emphasizes the need for evidence-based guidelines to guide our practices.[53] Other studies have shown similar poor compliance to set guidelines.[22],[27],[45],[53],[54]
Other poor-prescribing practices such as a lack of indications for therapy in 38.2% and the low rate of documentation of stop or review dates to guide the course of antimicrobials prescribed, resulted in healthcare staff leaving patients on these medications for inappropriate durations. These could be due to lack of justification of therapy and/or failure of documentation that shows the need for more quality-assured procedures and guidelines.[17] This, however, is not peculiar to Nigeria [28] and there appears to be a consensus that under this kind of conditions, it will be difficult to carry out an effective antimicrobial stewardship program without first correcting the deficiencies.[24],[34],[35] In addition, there was a very high rate of parenteral use of antimicrobials in all the hospitals, contrary to the advocated practices in antimicrobial stewardship program.[18],[43]
There was very little utilization of biomarkers (0.5%) such as procalcitonin across study hospitals because they are still rather novel in most parts of the country and are relatively expensive. However, they are a viable adjunct to guide therapy in select patients such as those in whom sepsis is suspected.[55] Biomarkers are no longer novel agents and are included in the current infection management guidelines.[56],[57] They are particularly useful to guide empiric antimicrobial therapy and for follow-up of antibiotic therapy of severe bacterial infections where it is desirable to achieve eradication of pathogens.[58],[59]
There is clearly a need to improve prescribing practices in the country by developing evidence-based guidelines, improving laboratories, and retraining prescribers on the importance of definitive or targeted therapy. This will require administrative will to ensure the use of culture and sensitivity results as the basis for antimicrobial therapy.
| Conclusions | | |
This study represents the first objective pan-hospital antimicrobial prescription evaluation in Nigeria. Areas of concern identified include high antibiotic prevalence rates in ICU, pediatric and neonatal wards combined with the absence of guidelines, low reporting of a stop/review date, and prolonged surgical prophylaxis. There is need to create awareness at the national level for targeted prescribing of antimicrobials and use of evidence-based antibiotic guidelines.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Ventola CL. The antibiotic resistance crisis: Part 1: Causes and threats.P T 2015;40:277-83.  [ PUBMED] |
| 2. | Rather IA, Kim BC, Bajpai VK, Park YH. Self-medication and antibiotic resistance: Crisis, current challenges, and prevention. Saudi J Biol Sci 2017;24:808-12. |
| 3. | Michael CA, Dominey-Howes D, Labbate M. The antimicrobial resistance crisis: Causes, consequences, and management. Front Public Health 2014;2:145. [ PUBMED] |
| 4. | Desalegn AA. Assessment of drug use pattern using WHO prescribing indicators at Hawassa university teaching and referral hospital, South Ethiopia: A cross-sectional study. BMC Health Serv Res 2013;13:170. [ PUBMED] |
| 5. | Munita JM, Bayer AS, Arias CA. Evolving resistance among gram-positive pathogens. Clin Infect Dis 2015;61 Suppl 2:S48-57. [ PUBMED] |
| 6. | Oliphant CM, Eroschenko K. Antibiotic resistance, part 1: gram-positive pathogens. J Nurs Pract 2015;11:70-8. |
| 7. | Woodford N. Biological counterstrike: Antibiotic resistance mechanisms of gram-positive cocci. Clin Microbiol Infect 2005;11 Suppl 3:2-1. [ PUBMED] |
| 8. | Sharifi-Mood B, Sanei-Moghaddam E, Ghasem-Zadeh I, Khosravi S. Occult hepatitis B virus infection among anti-HBc only positive individuals in the Southeast of Iran in high prevalence of HBV infection region. Iran Red Crescent Med J 2009;11:90-2. |
| 9. | Kanj SS, Kanafani ZA. Current concepts in antimicrobial therapy against resistant gram-negative organisms: Extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa. Mayo Clin Proc 2011;86:250-9. [ PUBMED] |
| 10. | Ruppé É, Woerther PL, Barbier F. Mechanisms of antimicrobial resistance in gram-negative bacilli. Ann Intensive Care 2015;5:61. |
| 11. | Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010;362:1804-13. [ PUBMED] |
| 12. | Hogan KA, Gazarin M, Lapenskie J. Development and implementation of an antimicrobial stewardship program in a rural hospital. Can J Hosp Pharm 2016;69:403-8. [ PUBMED] |
| 13. | File TM Jr., Srinivasan A, Bartlett JG. Antimicrobial stewardship: Importance for patient and public health. Clin Infect Dis 2014;59 Suppl 3:S93-6. |
| 14. | Gould IM. Benefits of antimicrobial stewardship in hospitals: Evidence from a recent cochrane review. J Microbiol Immunol Infect 2017;48:S24. |
| 15. | Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric antimicrobial stewardship program at a children's hospital. Pediatrics 2011;128:1062-70. [ PUBMED] |
| 16. | Chukwuani CM, Onifade M, Sumonu K. Survey of drug use practices and antibiotic prescribing pattern at a general hospital in Nigeria. Pharm World Sci 2002;24:188-95. [ PUBMED] |
| 17. | Bebell LM, Muiru AN. Antibiotic use and emerging resistance: How can resource-limited countries turn the tide? Glob Heart 2014;9:347-58. [ PUBMED] |
| 18. | Huttner B, Harbarth S, Nathwani D; ESCMID Study Group for Antibiotic Policies (ESGAP). Success stories of implementation of antimicrobial stewardship: A narrative review. Clin Microbiol Infect 2014;20:954-62. [ PUBMED] |
| 19. | World Health Organisation. Antimicrobial Resistance : A global threat. Essent Drugs Monit 2000;29:1. |
| 20. | Stenehjem E, Hersh AL, Sheng X, Jones P, Buckel WR, Lloyd JF, et al. Antibiotic use in small community hospitals. Clin Infect Dis 2016;63:1273-80. |
| 21. | Essack SY, Connolly C, Sturm AW. Antibiotic use and resistance in public-sector hospitals in KwaZulu-Natal. S Afr Med J 2005;95:865-70. [ PUBMED] |
| 22. | Kimang'a AN. A situational analysis of antimicrobial drug resistance in Africa: Are we losing the battle? Ethiop J Health Sci 2012;22:135-43. |
| 23. | Liew YX, Krishnan P, Yeo CL, Tan TY, Lee SY, Lim WP, et al. Surveillance of broad-spectrum antibiotic prescription in Singaporean hospitals: A 5-year longitudinal study. PLoS One 2011;6:e28751. [ PUBMED] |
| 24. | Hsu LY, Tan TY, Tam VH, Kwa A, Fisher DA, Koh TH, et al. Surveillance and correlation of antibiotic prescription and resistance of gram-negative bacteria in Singaporean hospitals. Antimicrob Agents Chemother 2010;54:1173-8. |
| 25. | Johnson AP. Surveillance of antibiotic resistance. Philos Trans R Soc Lond B Biol Sci 2015;370:20140080. [ PUBMED] |
| 26. | Magill SS, Edwards JR, Beldavs ZG, Dumyati G, Janelle SJ, Kainer MA, et al. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA 2014;312:1438-46. [ PUBMED] |
| 27. | Lee C, Walker SA, Daneman N, Elligsen M, Palmay L, Coburn B, et al. Point prevalence survey of antimicrobial utilization in a canadian tertiary-care teaching hospital. J Epidemiol Glob Health 2015;5:143-50. [ PUBMED] |
| 28. | Ansari F, Erntell M, Goossens H, Davey P. The European Surveillance of Antimicrobial Consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis 2009;49:1496-504. [ PUBMED] |
| 29. | Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H; ARPEC Project Group. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother 2016;71:1106-17. [ PUBMED] |
| 30. | Ustun C, Hosoglu S, Geyik MF, Parlak Z, Ayaz C. The accuracy and validity of a weekly point-prevalence survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey. Int J Infect Dis 2011;15:e684-7. [ PUBMED] |
| 31. | Bilal AI, Osman ED, Mulugeta A. Assessment of medicines use pattern using World Health Organization's Prescribing, Patient Care and Health facility indicators in selected health facilities in Eastern Ethiopia. BMC Health Serv Res 2016;16:144. [ PUBMED] |
| 32. | |
| 33. | Green T, Joshi MP, Noorzaee A, Siddiqui Z, Omari Z. How to Investigate Antimicrobial Use in Hospitals: Selected Indicators. In Strengthening Pharmaceutical Systems. Published for the U.S. Agency for International Development by the Strengthening Pharmaceutical Systems Program. Arlington, VA: Management Sciences for Health. 2012. p. 8-31. Available from: http://www.msh.org/projects/sps/SPS-Documents/ [Last accessed on 2017 Sep 23]. |
| 34. | Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc 2011;86:1113-23. [ PUBMED] |
| 35. | Evans RS, Olson JA, Stenehjem E, Buckel WR, Thorell EA, Howe S, et al. Use of computer decision support in an antimicrobial stewardship program (ASP). Appl Clin Inform 2015;6:120-35. [ PUBMED] |
| 36. | Ntšekhe M, Tjipura D. Antibiotic Prescribing Patterns at Six Hospitals in Lesotho. Submitt to US Agency International Development by Strength Pharmaceuticals System Program. Arlington, VA: Management Science Health Strength; 2011. p. 40. Available from: http://www.apps.who.int/medicinedocs/documents/s21028en/s21028en.pdf [Last accessed on 2017 Sep 24]. |
| 37. | Meyer HJ, Sibanda M. Appropriate use of antimicrobials: An ongoing and coordinated effort. SA Pharm J 2016;83:41-7. |
| 38. | Versporten A, Drapier N, Zarb P, Caniaux I, Gros MF, Miller M et al. The global point prevalence survey of antimicrobial consumption and resistance (Global-PPS): A worldwide antimicrobial web-based point prevalence survey. Open Forum Infect Dis 2015;2 Suppl 1:147. |
| 39. | Awad AI, Himad HA. Drug-use practices in teaching hospitals of Khartoum state, Sudan. Eur J Clin Pharmacol 2006;62:1087-93. [ PUBMED] |
| 40. | Talaat M, Saied T, Kandeel A, El-Ata GA, El-Kholy A, Hafez S, et al. A point prevalence survey of antibiotic use in 18 hospitals in Egypt. Antibiotics (Basel) 2014;3:450-60. [ PUBMED] |
| 41. | Paruk F, Richards G, Scribante J, Bhagwanjee S, Mer M, Perrie H, et al. Antibiotic prescription practices and their relationship to outcome in South Africa: Findings of the prevalence of infection in South African Intensive Care Units (PISA) study. S Afr Med J 2012;102:613-6. |
| 42. | |
| 43. | Tiong JJ, Loo JS, Mai CW. Global antimicrobial stewardship: A closer look at the formidable implementation challenges. Front Microbiol 2016;7:1860. [ PUBMED] |
| 44. | Petti CA, Polage CR, Quinn TC, Ronald AR, Sande MA. Laboratory medicine in Africa: A barrier to effective health care. Clin Infect Dis 2006;42:377-82. [ PUBMED] |
| 45. | Erbay A, Bodur H, Akinci E, Colpan A. Evaluation of antibiotic use in Intensive Care Units of a tertiary care hospital in Turkey. J Hosp Infect 2005;59:53-61. [ PUBMED] |
| 46. | Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: A global multifaceted phenomenon. Pathog Glob Health 2015;109:309-18. [ PUBMED] |
| 47. | World Health Organisation. Health care-associated infections FACT SHEET; p4. Available from: www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. [Last accessed on 2018 Jan 16]. |
| 48. | Emmerson M. Antibiotic usage and prescribing policies in the Intensive Care Unit. Intensive Care Med 2000;26 Suppl 1:S26-30. [ PUBMED] |
| 49. | Al-Shenqiti A, Bahashwan SA, Ghanem S, Manzoor N, El Shafey HM; Nosocomial infections in intensive care and medical rehabilitation units, and evaluation of antibiotics prescription. Afr J Microbiol Res 2017;11:776-83. |
| 50. | Kebede HK, Gesesew HA, Woldehaimanot TE, Goro KK. Antimicrobial use in paediatric patients in a teaching hospital in Ethiopia. PLoS One 2017;12:e0173290. |
| 51. | Ceyhan M, Yildirim I, Ecevit C, Aydogan A, Ornek A, Salman N, et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey. Int J Infect Dis 2010;14:e55-61. [ PUBMED] |
| 52. | Tyrstrup M, van der Velden A, Engstrom S, Goderis G, Molstad S, Verheij T, et al. Antibiotic prescribing in relation to diagnoses and consultation rates in belgium, the Netherlands and Sweden: Use of european quality indicators. Scand J Prim Health Care 2017;35:10-8. [ PUBMED] |
| 53. | Ng RS, Chong CP. Surgeons' adherence to guidelines for surgical antimicrobial prophylaxis – A review. Australas Med J 2012;5:534-40. [ PUBMED] |
| 54. | Gouvêa M, Novaes Cde O, Pereira DM, Iglesias AC. Adherence to guidelines for surgical antibiotic prophylaxis: A review. Braz J Infect Dis 2015;19:517-24. |
| 55. | Absolutereports.com. Global (North America, Europe and Asia-Pacific, South America, Middle East and Africa) Procalcitonin (CAS 56645-65-9) Market 2017 Forecast to 2022. Pune; 2017. Available from: https://www.absolutereports.com/11101460 [Last accessed on 2017 Sep 25]. |
| 56. | Rogić D, Juroš GF, Petrik J, Vrančić AL. Advances and pitfalls in using laboratory biomarkers for the diagnosis and management of sepsis. EJIFCC 2017;28:114-21. |
| 57. | Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43:304-77. [ PUBMED] |
| 58. | Dupuy AM, Philippart F, Péan Y, Lasocki S, Charles PE, Chalumeau M, et al. Role of biomarkers in the management of antibiotic therapy: An expert panel review: I - currently available biomarkers for clinical use in acute infections. Ann Intensive Care 2013;3:22. |
| 59. | Sager R, Kutz A, Mueller B, Schuetz P. Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Med 2017;15:15. |
[Figure 1]
[Table 1], [Table 2], [Table 3]
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Implementation of a multidisciplinary antimicrobial stewardship programme in a Philippine tertiary care hospital: an evaluation by repeated point prevalence surveys |
|
| Gina Betito,Ines Pauwels,Ann Versporten,Herman Goossens,Mari Rose De Los Reyes,Maria Tarcela Gler | | Journal of Global Antimicrobial Resistance. 2021; | | [Pubmed] | [DOI] | | | 12 |
A point prevalence survey of antimicrobial utilisation patterns and quality indices amongst hospitals in South Africa; findings and implications |
|
| PP Skosana,N Schellack,B Godman,A Kurdi,M Bennie,D Kruger,JC Meyer | | Expert Review of Anti-infective Therapy. 2021; | | [Pubmed] | [DOI] | | | 13 |
A multicentre point prevalence study of antibiotics utilization in hospitalised patients in an urban secondary and a tertiary healthcare facilities in Nigeria: findings and implications |
|
| Olayinka O. Ogunleye,Modupe R. Oyawole,Patricia T. Odunuga,Folasade Kalejaye,Adesola F. Yinka-Ogunleye,Adesola Olalekan,Sunday O. Ogundele,Bernard E. Ebruke,Atinuke Kalada Richard,Bene D Anand Paramadhas,Amanj Kurdi,Jacqueline Sneddon,Andrew Seaton,Brian Godman | | Expert Review of Anti-infective Therapy. 2021; | | [Pubmed] | [DOI] | | | 14 |
A multicentre point prevalence survey (PPS) of antimicrobial use amongst
admitted patients in tertiary care centres in India |
|
| Aditi M Panditrao, Nusrat Shafiq, Suparna Chatterjee, Ashish Pathak, Niyati Trivedi, Balakrishnan Sadasivam, Nilima Kshirsagar, Rajni Kaul, Manisha Biswal, Ashish Kakkar, Samir Malhotra, Pankaj Arora, Shweta Talati, Navneet Dhaliwal, Avijit Hazra, Ratinder Jhaj, Ahmad Najmi, Navin Pandey, Raja Chakraverty, Saman Pathan, Janki Chauhan, Aditya Mathur, Amritpal Sekhon, Anurag Sarao, Aqeel Haider, Avaneesh
Kumar Pandey, Chakrant Mothsara, K Chandrahasan, C V
N Harish Kumar, Devaraj Belavigi, Geetika Arora, Gopal Vishwas, Harinder Kaur, Harpreet Kaur, Imran Ibni
Gani Rather, Kulbeer Kaur, Janagiraman Kumaravel, Naveen Murali, Manav Jain, Nanda Gamad, Praveen Kumar-M, Priyanka Sharma, Rachna Rohilla, Ritika
Kondel Bhandari, Rupinder Maini, Surria Rajpoot, Varnit Kaushik, Vidya Mahalmani, Kalyan Samanta, Poulami
Roy Choudhury, Dolon Chakraborty, Abhijnan Ghosh, Priyanka
Guha | | Journal of Antimicrobial Chemotherapy. 2021; 76(4): 1094 | | [Pubmed] | [DOI] | | | 15 |
Antibiotic prescribing in inpatient and outpatient settings in Iran: a systematic review and meta-analysis study |
|
| Ehsan Nabovati,Zhila TaherZadeh,Saeid Eslami,Ameen Abu-Hanna,Reza Abbasi | | Antimicrobial Resistance & Infection Control. 2021; 10(1) | | [Pubmed] | [DOI] | | | 16 |
A Point Prevalence Survey Of Antimicrobial Prescribing In A South Indian Tertiary Hospital; Using Global PPS Tool |
|
| Vineela Chadalavada,Manohar Babu S,Balamurugan K | | Asian Journal of Pharmaceutical Research and Health Care. 2021; 13(1): 70 | | [Pubmed] | [DOI] | | | 17 |
Prevalence and antimicrobial susceptibility profile of multidrug-resistant bacteria among intensive care units patients at Ain Shams University Hospitals in Egypt—a retrospective study |
|
| Noha Alaa Eldin Fahim | | Journal of the Egyptian Public Health Association. 2021; 96(1) | | [Pubmed] | [DOI] | | | 18 |
Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria |
|
| Dimie Ogoina,Garba Iliyasu,Vivian Kwaghe,Akan Otu,Iorhen Ephram Akase,Olukemi Adekanmbi,Dalhat Mahmood,Micheal Iroezindu,Shamsudin Aliyu,Abisoye Sunday Oyeyemi,Stella Rotifa,Mukhtar Abdulmajid Adeiza,Uche Sonny Unigwe,Juliet Ijeoma Mmerem,Farouq Muhammad Dayyab,Zaiyad Garba Habib,Daniel Otokpa,Emmanuel Effa,Abdulrazaq Garba Habib | | Antimicrobial Resistance & Infection Control. 2021; 10(1) | | [Pubmed] | [DOI] | | | 19 |
Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital |
|
| Nurul Adilla Hayat Jamaluddin,Petrick Periyasamy,Chee Lan Lau,Sasheela Ponnampalavanar,Pauline Siew Mei Lai,Ramliza Ramli,Toh Leong Tan,Najma Kori,Mei Kuen Yin,Nur Jannah Azman,Rodney James,Karin Thursky,Isa Naina-Mohamed | | Antibiotics. 2021; 10(5): 531 | | [Pubmed] | [DOI] | | | 20 |
A point prevalence survey study (PPS) of antimicrobial consumption in a tertiary care super-speciality hospital of West Bengal |
|
| Raja Chakraverty,Kalyan Samanta | | Indian Journal of Pharmacy and Pharmacology. 2021; 8(3): 200 | | [Pubmed] | [DOI] | | | 21 |
Antimicrobial Usage and Resistance in Makkah Region Hospitals: A Regional Point Prevalence Survey of Public Hospitals |
|
| Abdul Haseeb, Hani Saleh Faidah, Manal Algethamy, Saleh Alghamdi, Ghaidaa Ali Alhazmi, Afnan Owedah Alshomrani, Bashair Rjyan Alqethami, Hind Saeed Alotibi, Maali Zayed Almutiri, Khawlah Saad Almuqati, Amjad Abdullah Albishi, Mahmoud Essam Elrggal, Ahmad Jamal Mahrous, Asim Abdulaziz Khogeer, Zikria Saleem, Muhammad Shahid Iqbal, Aziz Sheikh | | International Journal of Environmental Research and Public Health. 2021; 19(1): 254 | | [Pubmed] | [DOI] | | | 22 |
Antimicrobial resistance awareness and antibiotic prescribing behavior among healthcare workers in Nigeria: a national survey |
|
| Emelda E. Chukwu,David A. Oladele,Christian A. Enwuru,Peter L. Gogwan,Dennis Abuh,Rosemary A. Audu,Folasade T. Ogunsola | | BMC Infectious Diseases. 2021; 21(1) | | [Pubmed] | [DOI] | | | 23 |
Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey |
|
| Jeremiah Seni,Siana G Mapunjo,Rachel Wittenauer,Richard Valimba,Andy Stergachis,Brian J Werth,Samir Saitoti,Noel H Mhadu,Edgar Lusaya,Niranjan Konduri | | BMJ Open. 2020; 10(12): e042819 | | [Pubmed] | [DOI] | | | 24 |
Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey |
|
| Usman Abubakar | | BMC Infectious Diseases. 2020; 20(1) | | [Pubmed] | [DOI] | | | 25 |
Point prevalence surveys of antimicrobial use: a systematic review and the implications |
|
| Zikria Saleem,Mohamed Azmi Hassali,Brian Godman,Ann Versporten,Furqan Khurshid Hashmi,Hamid Saeed,Fahad Saleem,Muhammad Salman,Inayat Ur Rehman,Tahir Mehmood Khan | | Expert Review of Anti-infective Therapy. 2020; : 1 | | [Pubmed] | [DOI] | | | 26 |
Addressing antimicrobial resistance in Nigerian hospitals: exploring physicians prescribing behavior, knowledge and perception of antimicrobial resistance and stewardship programs |
|
| Adefunke O Babatola,Joseph O Fadare,Oladele S Olatunya,Reginald Obiako,Okezie Enwere,Aubrey Kalungia,Temitope O Ojo,Taofeek A Sunmonu,Olufemi Desalu,Brian Godman | | Expert Review of Anti-infective Therapy. 2020; | | [Pubmed] | [DOI] | | | 27 |
QuEChERS Approach for the Analysis of Three Fluoroquinolone Antibiotics in Wastewater: Concentration Profiles and Ecological Risk in Two Nigerian Hospital Wastewater Treatment Plants |
|
| Akinranti S. Ajibola,Oluwasegun A. Amoniyan,Faith O. Ekoja,Florence O. Ajibola | | Archives of Environmental Contamination and Toxicology. 2020; | | [Pubmed] | [DOI] | | | 28 |
Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship |
|
| Chukwuma David Umeokonkwo,Ugochukwu Chinyem Madubueze,Cosmas Kenan Onah,Ijeoma N. Okedo-Alex,Azuka Stephen Adeke,Ann Versporten,Herman Goossens,Dorothy Igwe-Okomiso,Kingsley Okeke,Benedict N. Azuogu,Robinson Onoh | | Journal of Global Antimicrobial Resistance. 2019; 17: 291 | | [Pubmed] | [DOI] | |
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