2034. Standardized Point Prevalence Survey on Antibiotic Use to Inform Antimicrobial Stewardship Strategies in the Caribbean

Abstract

BackgroundInappropriate use of antimicrobials is one of the core contributors to antimicrobial resistance. While hospitals create high selection pressures on bacteria due to the high quantity and broader spectrum of antibiotics used, information on antimicrobial use at the patient level in the Caribbean is sparse. In response, PAHO implemented a standardized WHO methodology to engage national leaderships, build local capacity, and facilitate the use of data to inform antimicrobial stewardship programs (ASP) in the Caribbean.MethodsPoint prevalence surveys (PPS) were performed in four acute care hospitals in Barbados, Guyana and Saint Lucia between June and July 2018. Medical records of all inpatients were reviewed to collect information on antibiotic use, indications and use of laboratory services (Figure 1). A hospital questionnaire was used to assess hospital infrastructure, policy and practices, and monitoring and feedback systems (Figure 2). Training on PPS methods and electronic data collection tool in REDCap™ were provided to build local capacity and identify potential ASP leaderships. A standardized data validation, analysis and reporting system was built in R to streamline the process. Results and recommendations were disseminated to national authorities and stakeholders to support hospital and national decision-making and training for healthcare providers (Figure 3).ResultsA total of 60 physicians, nurses, pharmacists, laboratory technicians, and infection control specialists were trained and participated in the PPS. The survey collected records of 816 patients in which 442 (54%) were females and 374 (46%) were males. In total, 356 (44%) patients received 551 antibiotics. Overall, 300 (75%) of 398 indications for antibiotic use were treatment and 72 (18%) were prophylaxis. A higher use of parenteral antibiotics (79%) was observed compared with oral antibiotics (21%). Antibiotic prescribing patterns differed across hospitals. The most commonly used antibiotics were metronidazole (12%) and amoxicillin/clavulanate (11%).ConclusionThe PPS method provided a feasible and effective way to collect baseline data and identify target areas for interventions. Engaging national leaderships and building local capacity offered a sustainable way in optimizing antimicrobial use in resource-limited settings. Disclosures All authors: No reported disclosures.

Point prevalence survey of antibiotic use in hospitals in Latin American countries

“…This type of survey permits (i) the measurement of antimicrobial use along time, assessing changes in prescribing trends; (ii) the identification of targets for quality improvement in different hospital wards; and (iii) the evaluation of the effectiveness of interventions implemented in response to indicators identified during previous surveys. 4 PPSs have been used in global 5 and regional studies in the Caribbean 6 and Europe, 7 as well as in country-level studies in China, 8 Saudi Arabia, 9 the USA 10 and Viet Nam, 11 among others. 12–14 …”

Reporting on antibiotic use patterns using the WHO Access, Watch, Reserve classification in the Caribbean

“…The COVID-19 pandemic presents an opportunity for more comprehensive antimicrobial use surveillance. In the clinical management of COVID-19, increases in unnecessary antimicrobial use could potentiate future AMR risks by driving the selection of multidrug resistant and extensively drug-resistant organisms (4,27). Through an international web-based survey of physicians involved in the treatment of COVID-19, Beovi et al (28) concluded early in the pandemic that broad-spectrum antibiotic use in patients with COVID-19 was widespread.…”

“…In a November 2021 Latin America and Caribbean update, PAHO data indicated that over 90% of inpatient COVID-19 cases were treated with antimicrobials, while only 7% had a secondary infection (29). Among the most common antibiotics used were piperacillin-tazobactam (AWaRe Watch), which Forde et al demonstrated in 2013 was a predictor for carbapenem-resistant K. pneumoniae carriage in the Caribbean (4,21).…”

“…The growing global threat of antimicrobial resistance (AMR) disproportionately affects low-and middle-income countries, like 79% of those in Latin America and the Caribbean (1,2). Following the collective commitment by the Caribbean Community (CARICOM) to develop national action plans on AMR by 2017, the Pan American Health Organization (PAHO) has supported a series of strategic activities for focused outcomes in the health of people, animals, and ecosystems (3)(4)(5). PAHO thus recognized a need to conduct a pre-implementation assessment of antibiotic use in acute care settings using the World Health Organization (WHO) Point Prevalence Survey (PPS), developed to guide decision-making (2).…”