Zumaya-Estrada Federico A, Alpuche-Aranda Celia M, Huerta Icelo Hilda Ivonne, Neri-Estrada Felipe D, Calixto Silva Verónica M, Quiroz Escoriza Haydee E, Garza-Ramos Jesus Ulises, Saturno-Hernandez Pedro J
National Institute of Public Health of Mexico, Center for Infectious Diseases Research, Cuernavaca, Morelos, Mexico.
Pharmacovigilance Unit, General Hospital of Cuernavaca "Dr. José G. Parres", Health Services of Morelos, Cuernavaca, Morelos, Mexico.
PLoS One. 2025 Jan 3;20(1):e0315925. doi: 10.1371/journal.pone.0315925. eCollection 2025.
Tackling the inertia of growing threat of antimicrobial resistance (AMR) requires changes in how antibiotics are prescribed and utilized. The monitoring of antimicrobial prescribing in hospitals is a critical component in optimizing antibiotic use. Point prevalence surveys (PPSs) enable the surveillance of antibiotic prescribing at the patient level in small hospitals that lack the resources to establish antimicrobial stewardship programs (ASP). In this study, we analyzed antibiotic use at two public secondary care hospitals in Mexico using PPSs.
Following WHO methodology, we conducted four cross-sectional PPSs on antibiotic use in two public secondary care facilities in Mexico: two surveys in a women's specialty hospital (H1) and two in a general referral hospital (H2). We collected data from clinical records of all patients with active antibiotic prescriptions (APs) across the medical, surgical, and mixed (MIX) wards, and intensive care units (ICUs). Descriptive statistics were computed to analyze the PPSs data using Stata.
The PPSs collected data on 127 patients, and 283 active APs. The prevalence of antibiotic use was 60.4% (H1, n = 29/48) and 70.5% (H2, n = 98/139). Antibiotics were more frequently used among patients in the MIX wards (H1: 87.5%, n = 14/16) and ICUs (H2: 90%, n = 9/10). The most frequent patient indications for antibiotic use were medical prophylaxis (H1: 51.7%, n = 15/29), community-acquired infections (H2: 42.9%, n = 42/98), and preoperative prophylaxis (H1: 27.6%, n = 8/29; H2: 23.5%, n = 23/98). The APs were mostly empirical (H1: 97%, n = 64/66; H2: 98.2%, n = 213/217), and parenterally administered (H1: 90.9%, n = 60/66; H2: 96.8%, n = 210/217). Most clinical records lacked documented post-prescription reviews (H1: 82.8%, n = 24/29; H2: 98%, n = 96/98). Preoperative prophylaxis was predominantly administered as multiple doses for more than one day. Penicillins with extended-spectrum (24.2%, n = 16/66), aminoglycosides (22.7%, n = 15/66), and first-generation cephalosporins (16.7%, n = 11/66) were the most prescribed antibiotic classes in H1, while third-generation cephalosporins (35%, n = 76/217), fluoroquinolones (14.3%, n = 31/217), and carbapenems (13.4%, n = 29/217) were the most prescribed in H2. No hospital had formally established ASP.
This study shows high prevalence rates of antibiotic use and variations in commonly prescribed antibiotic classes in public Mexican secondary care hospitals, along with shared practices in broad-spectrum antibiotic prescription. PPS-based surveillance enables the identification of specific targets to optimize antibiotic use according to the healthcare needs of patients in each hospital and facilitates comparative evaluations across hospitals.
应对日益增长的抗菌药物耐药性（AMR）威胁的惰性需要改变抗生素的处方和使用方式。医院对抗菌药物处方的监测是优化抗生素使用的关键组成部分。现患率调查（PPS）能够在缺乏建立抗菌药物管理计划（ASP）资源的小型医院中，对患者层面的抗生素处方进行监测。在本研究中，我们使用PPS分析了墨西哥两家公立二级医疗机构的抗生素使用情况。
按照世界卫生组织的方法，我们在墨西哥的两家公立二级医疗机构进行了四次关于抗生素使用的横断面PPS：在一家妇女专科医院（H1）进行了两次调查，在一家综合转诊医院（H2）进行了两次调查。我们从医疗、外科和混合（MIX）病房以及重症监护病房（ICU）中所有有活性抗生素处方（AP）的患者的临床记录中收集数据。使用Stata计算描述性统计数据以分析PPS数据。
PPS收集了127名患者和283份活性AP的数据。抗生素使用患病率为60.4%（H1，n = 29/48）和70.5%（H2，n = 98/139）。在MIX病房（H1：87.5%，n = 14/16）和ICU（H2：90%，n = 9/10）的患者中抗生素使用更为频繁。抗生素使用最常见的患者指征是医学预防（H1：51.7%，n = 15/29）、社区获得性感染（H2：42.9%，n = 42/98）和术前预防（H1：27.6%，n = 8/29；H2：23.5%，n = 23/98）。AP大多是经验性的（H1：97%，n = 64/66；H2：98.2%，n = 213/217），并且通过胃肠外给药（H1：90.9%，n = 60/66；H2：96.8%，n = 210/217）。大多数临床记录缺乏处方后审查的记录（H1：82.8%，n = 24/29；H2：98%，n = 96/98）。术前预防主要以多剂量给药超过一天。广谱青霉素（24.2%，n = 16/66）、氨基糖苷类（22.7%，n = 15/66）和第一代头孢菌素（16.7%，n = 11/66）是H1中最常处方的抗生素类别，而第三代头孢菌素（35%，n = 76/217）、氟喹诺酮类（14.3%，n = 31/217）和碳青霉烯类（13.4%，n = 29/217）是H2中最常处方的。没有医院正式建立ASP。
本研究表明，墨西哥公立二级医疗机构中抗生素使用率高，常用抗生素类别存在差异，同时广谱抗生素处方存在共同做法。基于PPS的监测能够确定特定目标以根据每家医院患者的医疗需求优化抗生素使用，并有助于跨医院进行比较评估。
