Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South
Nokuthula N Dlamini1, Johanna C Meyer1, Danie Kruger1,2
1a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.
Insights
Antimicrobial use in South African public hospitals was studied using point prevalence surveys (PPS). While most prescriptions align with guidelines, some are unnecessary, and IV to oral switching is lacking.
Area of Science:
- Pharmacology
- Infectious Diseases
- Public Health
Background:
- Limited data exists on antimicrobial use in South African public hospitals.
- Rising antimicrobial resistance necessitates better understanding of prescribing practices.
Purpose of the Study:
- Assess the suitability of point prevalence surveys (PPS) for antimicrobial utilization studies in South Africa.
- Determine current antimicrobial prescribing patterns in a public hospital.
- Evaluate antimicrobial use against national Essential Medicines List and Standard Treatment Guidelines (EML/STGs).
Main Methods:
- A point prevalence survey (PPS) was conducted in Dr George Mukhari Academic Hospital.
- Patient files from all inpatient wards were surveyed on a single day.
- Antimicrobial use prevalence was calculated as (patients on antimicrobials / total patients) per ward.
Main Results:
- Overall antimicrobial prevalence was 37.7%, with highest rates in ICUs.
- Beta-lactamase inhibitors and tuberculosis antimicrobials were most common.
- 83% of treatments were modified post-culture, 98% of prescriptions followed EML/STGs, but 10.8% lacked clear infection indication. IV to oral switching was infrequent.
Conclusions:
- PPS is a valuable tool for identifying quality improvement targets in antimicrobial prescribing.
- Challenges include the time required for PPS in resource-limited settings.
- Addressing unnecessary prescribing and improving IV to oral switching are key areas for improvement.
Objectives:
There is currently a lack of data regarding antimicrobial use among public hospitals in South Africa. This is a concern given their growing use and increasing antimicrobial resistance rates in South Africa. Consequently, the objectives of this study were to firstly determine the appropriateness of point prevalence survey (PPS) data collection instruments for performing antimicrobial utilization studies among public sector hospitals in South Africa; secondly, to determine current antimicrobial utilization in a public sector hospital, and thirdly evaluate the prescribing of antimicrobials with those contained within the national Essential Medicines List and Standard Treatment Guidelines (EML/STGs). The findings will be used to guide future activities in South Africa.
Methods:
A PPS was conducted in Dr George Mukhari Academic Hospital. For each in-patient ward, all patients' files were completely surveyed on a single day. The number of patients who were on antimicrobials served as the numerator and the denominator comprised the total number of patients in the ward.
Results:
39 wards and 512 patient files were surveyed. The overall prevalence of antimicrobial use was 37.7%, highest in the ICUs. Beta lactamase inhibitors and antimicrobials for tuberculosis were the most prevalent antimicrobials. More than two thirds (83%) of antimicrobial treatment was modified following culture sensitivity test results when requested, and 98% of antimicrobials prescribed were contained within the current EML/STGs. In 10.8% of occasions, antimicrobials appear to have been prescribed other than for treatment, i.e. no systemic infection. There were concerns though with the lack of IV to oral switching.
Conclusion:
The PPS method offers a standardized tool that can be used to identify targets for quality improvement. However, there were concerns with the time taken to conduct PPS studies, which is an issue in resource limited settings. This is being addressed alongside concerns with the lack of IV to oral switching.
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