Limato Ralalicia, Nelwan Erni J, Mudia Manzilina, de Brabander Justin, Guterres Helio, Enty Enty, Mauleti Ifael Y, Mayasari Maria, Firmansyah Iman, Hizrani May, Hamers Raph L
Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia.
Department of Internal Medicine, Division of Infectious Diseases, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
JAC Antimicrob Resist. 2021 Apr 26;3(2):dlab047. doi: 10.1093/jacamr/dlab047. eCollection 2021 Jun.
The global emergence of antimicrobial resistance is driven by antibiotic misuse and overuse. However, systematic data in Indonesian hospitals to adequately inform policy are scarce.
To evaluate patterns and quality indicators of antibiotic prescribing in six general hospitals in Jakarta, Indonesia.
We conducted a hospital-wide point prevalence survey (PPS) between March and August 2019, using Global-PPS and WHO-PPS protocols. The analysis focused on antibacterials (antibiotics) for systemic use.
Of 1602 inpatients, 993 (62.0%) received ≥1 antimicrobial. Of 1666 antimicrobial prescriptions, 1273 (76.4%) were antibiotics. Indications comprised community-acquired infections (42.6%), surgical prophylaxis (22.6%), hospital-acquired infections (18.5%), medical prophylaxis (9.6%), unknown (4.6%) and other (2.1%). The most common reasons for antibiotic prescribing were pneumonia (27.7%), skin and soft tissue infections (8.3%), and gastrointestinal prophylaxis (7.9%). The most prescribed antibiotic classes were third-generation cephalosporins (44.3%), fluoroquinolones (13.5%), carbapenems (7.4%), and penicillins with β-lactamase inhibitor (6.8%). According to the WHO AWaRe classification, Watch antibiotics accounted for 67.4%, followed by 28.0% Access and 2.4% Reserve. Hospital antibiotic guidelines were not available for 28.1% of prescriptions, and, where available, guideline compliance was 52.2%. Reason for the antibiotic prescription, stop/review date and planned duration were poorly documented. Culture-guided prescriptions comprised 8.1% of community-acquired infections and 26.8% of hospital-acquired infections.
Our data indicate a high rate of empirical use of broad-spectrum antibiotics in Indonesian hospitals, coupled with poor documentation and guideline adherence. The findings suggest important areas for antimicrobial stewardship interventions.
抗生素的滥用和过度使用推动了全球抗菌药物耐药性的出现。然而，印度尼西亚医院中缺乏能够充分为政策提供依据的系统性数据。
评估印度尼西亚雅加达六家综合医院抗生素处方的模式和质量指标。
我们于2019年3月至8月期间，采用全球点患病率调查（Global-PPS）和世界卫生组织点患病率调查（WHO-PPS）方案，在全院范围内开展了点患病率调查（PPS）。分析重点为全身用抗菌药物（抗生素）。
在1602名住院患者中，993名（62.0%）接受了≥1种抗菌药物治疗。在1666份抗菌药物处方中，1273份（76.4%）为抗生素。用药指征包括社区获得性感染（42.6%）、手术预防（22.6%）、医院获得性感染（18.5%）、医疗预防（9.6%）、不明（4.6%）和其他（2.1%）。抗生素处方最常见的原因是肺炎（27.7%）、皮肤和软组织感染（8.3%）以及胃肠道预防（7.9%）。处方量最多的抗生素类别为第三代头孢菌素（44.3%）、氟喹诺酮类（13.5%）、碳青霉烯类（7.4%）以及含β-内酰胺酶抑制剂的青霉素类（6.8%）。根据世界卫生组织的AWaRe分类，“观察类”抗生素占67.4%，其次是“可及类”抗生素占28.0%，“储备类”抗生素占2.4%。28.1%的处方没有医院抗生素指南，即便有指南，指南依从率也仅为52.2%。抗生素处方的理由、停药/复查日期和计划疗程记录不完善。根据培养结果指导的处方在社区获得性感染中占8.1%，在医院获得性感染中占26.8%。
我们的数据表明，印度尼西亚医院中经验性使用广谱抗生素率很高，同时记录不完善且对指南的依从性差。这些发现提示了抗菌药物管理干预的重要领域。
