Service d'Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France.
Équipe Santé Publique, Epidémiologie et Eco-évolution des Maladies Infectieuses (PHE 3 ID), Centre International de Recherche en Infectiologie (CIRI), Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France.
BMC Infect Dis. 2024 Aug 13;24(1):818. doi: 10.1186/s12879-024-09614-4.
The increase and global dissemination of antibiotic resistance limit the use of antibiotics to prevent and treat infections. Implementing antibiotic stewardship programs guided by local data on prescription profiles is a useful strategy to reduce the burden of antibiotic resistance. The aim was to determine the prevalence of antibiotic use and guideline compliance at Luang Prabang provincial hospital, Lao PDR.
A point prevalence survey of antibiotics was conducted among hospitalized patients admitted to Luang Prabang hospital (204 beds) in Lao PDR on May 25, 2023. All patients presenting at 8:00 AM were eligible. Sociodemographic data, indications for antibiotic use, and antibiotic prescriptions were collected from medical records using a paper-based questionnaire and entered into an electronic platform following WHO methodology. The prevalence of antibiotic use was determined.
Out of the 102 patients included, 60(58.8%) were undergoing antibiotic treatment, of which 33(55.0%) received combination therapy, and 7(10.5%) had two indications for antibiotic use. The highest prevalence was in the surgical ward (14/15, 93%) followed by general paediatrics (18/27, 67%). Out of the 100 antibiotic prescriptions, 47(47%) were for community-acquired infections, 26(26%) for surgical prophylaxis, 13(13%) for hospital-acquired infections and 5(5%) for medical prophylaxis. Twenty(20%) antibiotics were prescribed for obstetrics and gynaecology prophylaxis, 17(17%) for intra-abdominal infections, and 10(10.0%) for pneumonia treatment as well as bone, and joint infections. The main antibiotics prescribed were ceftriaxone 36(34.6%), metronidazole 18(17.3%), ampicillin 8(7.7%), and gentamicin 8(7.7%). Only 2(3%) samples were sent to the laboratory, one of which showed a positive culture for Escherichia coli Extended Spectrum β-Lactamase. According to the WHO Access Watch and Reserve classification, 55(52.9%) molecules belonged to the Access category, 47(49.1%) to the Watch category, and none to the Reserve category. Only 14.9% of antibiotic prescriptions were fully compliant with current guidelines.
This study indicated a significant prevalence of antibiotic use and a very low compliance with guidelines at Luang Prabang provincial hospital, Lao PDR. This highlights an urgent need for comprehensive strategies at all levels to optimize antibiotic use in hospitals, emphasizing diagnostic improvements, and continued research to address the factors driving this excessive antibiotic usage and improve adherence to guidelines.
抗生素耐药性的增加和全球传播限制了抗生素的使用，以预防和治疗感染。实施基于当地处方模式数据的抗生素管理计划是减少抗生素耐药性负担的有用策略。本研究旨在确定老挝琅勃拉邦省医院抗生素的使用情况和指南遵循率。
2023 年 5 月 25 日，对老挝琅勃拉邦省医院（204 张床位）住院患者进行了抗生素使用的时点患病率调查。所有在上午 8 点就诊的患者均符合入选条件。使用纸质问卷收集患者的社会人口学数据、抗生素使用指征和抗生素处方，并按照世界卫生组织方法录入电子平台。确定抗生素使用的患病率。
102 例患者中，60 例（58.8%）正在接受抗生素治疗，其中 33 例（55.0%）接受联合治疗，7 例（10.5%）有两个抗生素使用指征。手术病房的抗生素使用患病率最高（14/15，93%），其次是普通儿科（18/27，67%）。100 份抗生素处方中，47 份（47%）用于社区获得性感染，26 份（26%）用于手术预防，13 份（13%）用于医院获得性感染，5 份（5%）用于医疗预防。20 份（20%）抗生素用于妇产科预防，17 份（17%）用于腹腔内感染，10 份（10.0%）用于肺炎、骨和关节感染的治疗。主要使用的抗生素是头孢曲松 36 份（34.6%）、甲硝唑 18 份（17.3%）、氨苄西林 8 份（7.7%）和庆大霉素 8 份（7.7%）。仅 2 份（3%）样本送往实验室，其中一份大肠杆菌产超广谱β-内酰胺酶的培养结果阳性。根据世界卫生组织获取途径观察站和储备分类，55 种（52.9%）分子属于获取类别，47 种（49.1%）属于观察类别，没有储备类别。只有 14.9%的抗生素处方完全符合现行指南。
本研究表明，老挝琅勃拉邦省医院抗生素的使用情况非常普遍，且指南的遵循率很低。这突出表明，急需在各级实施全面的策略，以优化医院的抗生素使用，强调改善诊断，并持续研究驱动这种过度使用抗生素的因素，提高对指南的遵循率。
