Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications

Saleem, Zikria; Haseeb, Abdul; Godman, Brian; Batool, Narjis; Altaf, Ummara; Ahsan, Umar; Khan, Faiz Ullah; Khan, Amer Hayat; Nadeem, Muhammad Umer; Farrukh, Muhammad Junaid; Mugheera, Muhammad; Rehman, Inaam Ur; Khan, Asma Fareed; Saeed, Hamid; Hossain, Mohammad Akbar; Raafat, Mohamed; Radwan, Rozan Mohammad; Iqbal, Muhammad Shahid

doi:10.3390/antibiotics12010070

Cited by 15 publications

(22 citation statements)

References 126 publications

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“…These include a lack of awareness and non-compliance with current international guidelines among physicians, i.e., perceiving that such guidelines are not directly attributable to their hospital and setting, concerns with the cleanliness of their wards, a general lack of infection control practices due to resource issues as well as a lack of trust in the validity of antimicrobial susceptibility data in the hospital [ 17 , 53 , 54 , 55 ]. Our findings regarding the extensive prescription of antimicrobials post-operatively for SAP are similar to those of a study by Khan et al (2020), as well as one by Saleem et al (2023), in Pakistan alongside other LMICs ( Supplementary Table S1 ), and this issue urgently needs to be addressed going forward [ 55 , 56 ]. Our findings are different from those of a recent study in Ethiopia, where 97.4% of patients who were administered antibiotics for SAP were prescribed a single dose.…”

Section: Discussionsupporting

confidence: 88%

“…Unnecessary prescription of ‘Watch’ and ‘Reserve’ antibiotics should be reduced as part of an effort to reduce resistance rates within a country [ 59 , 60 , 61 ]. This is particularly important in Pakistan given the high rates of AMR in the country, generally high rates of prescription of ‘Watch’ and ‘Reserve’ antibiotics within hospitals and the urgent need to reduce AMR as part of the agreed National Action Plan [ 52 , 56 , 62 , 63 , 64 , 65 ]. The National Institute of Health (NIH) of Pakistan has recognized the impact of HAIs-initiated activities attempting implement infection control training programs and provide the necessary infrastructure to support prevention programs as part of the agreed National Action Plan (NAP) to reduce AMR in Pakistan [ 62 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

et al. 2023

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Antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs) post-operatively. However, there are concerns with the extent of prophylaxis post-operatively, especially in low- and middle-income countries (LMICs). This increases antimicrobial resistance (AMR), which is a key issue in Pakistan. Consequently, we conducted an observational cross-sectional study on 583 patients undergoing surgery at a leading teaching hospital in Pakistan with respect to the choice, time and duration of antimicrobials to prevent SSIs. The identified variables included post-operative prophylactic antimicrobials given to all patients for all surgical procedures. In addition, cephalosporins were frequently used for all surgical procedures, and among these, the use of third-generation cephalosporins was common. The duration of post-operative prophylaxis was 3–4 days, appreciably longer than the suggestions of the guidelines, with most patients prescribed antimicrobials until discharge. The inappropriate choice of antimicrobials combined with prolonged post-operative antibiotic administration need to be addressed. This includes appropriate interventions, such as antimicrobial stewardship programs, which have been successful in other LMICs to improve antibiotic utilization associated with SSIs and to reduce AMR.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

et al. 2023

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“…There have been similar concerns regarding AMR and ASP awareness among students in African countries, as well as among HCPs in a number of LMICs [65,87,88,104,105]. This is an issue that needs to be urgently addressed given increasing concerns regarding the high rates of the inappropriate prescribing of antimicrobials and AMR in Pakistan [13,48,52,55,106]. These concerns may be due to a lack of information regarding ASPs and their importance in the current curriculum, which needs to be urgently addressed.…”

Section: Discussionmentioning

confidence: 99%

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications

Raees

Atif²,

Aslam

et al. 2023

Antibiotics

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Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261–7.094; p < 0.001) and age (OR = 0.524, CI = 0.327–0.842; p < 0.008) were among the key factors impacting students’ training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.

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“…Punjab was selected for this study because it is the most populus province in Pakistan, with a number of previous studies undertaken by the co-authors in the province, including patients with COVID-19, serving as comparators [ 23 , 39 , 86 , 87 , 88 , 89 , 90 ]. Moreover, these tertiary care/teaching hospitals were equipped with adequate medical personnel, laboratory facilities and personal protective equipment, as well as medicines for the effective management of children admitted with COVID-19.…”

Section: Methodsmentioning

confidence: 99%

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

et al. 2023

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There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19, increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children, including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals, including the clinical manifestations, laboratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19-positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to the ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). Further, 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤5 days (57.5), with most being ‘Watch’ antibiotics (80.4%). Increased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Excessive antibiotic prescribing among hospitalized neonates and children, despite very low bacterial co-infections or secondary bacterial infections, requires urgent attention to reduce AMR.

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Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications

Cited by 15 publications

References 126 publications

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

Antibiotic Utilization Patterns for Different Wound Types among Surgical Patients: Findings and Implications

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

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