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Updated: Jun 26, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Point-prevalence survey of antimicrobial use in intensive care units in Nepal
Sabin Koirala1, Agnimshwor Dahal2, Hem Raj Paneru2
1Hospital for Advanced Medicine and Surgery (HAMS), Kathmandu, Nepal.
Objective:
This study aimed to investigate the prevalence and practices of antibiotic use in intensive care units (ICUs) in Nepal and to identify potential areas for implementing antimicrobial stewardship programs.
Design:
A point prevalence survey was conducted to characterize and quantify the antimicrobial utilization in level III ICUs of Nepal.
Methods:
Data on antibiotic prescription rates, reasons for prescribing antibiotics, and prescribing practices were collected and analyzed. The prevalence of antimicrobial resistance was also assessed.
Results:
The antibiotic prescribing rate was found to be very high, with 92.85% of patients in ICU on antibiotics. Prolonged surgical prophylaxis was the most common reason for prescribing antibiotics. Empirical therapy accounted for 67.5% of all antibiotic prescriptions. Prescribing practices were poor, with low adherence to guidelines and best practices. Broad-spectrum antibiotics were commonly used even for surgical prophylaxis or community-acquired infections. High resistance was observed against commonly used antibiotics.
Conclusions:
The study underscores the urgent need for effective antimicrobial stewardship programs in ICUs of Nepal. Implementing robust stewardship programs could help optimize antibiotic utilization, improve patient outcomes, and combat the global threat of antimicrobial resistance. The findings serve as a stepping stone toward understanding and improving antibiotic prescribing practices in ICUs of Nepal.
Insights
Antibiotic use in Nepal
Area of Science:
- Critical care medicine
- Infectious diseases
- Pharmacology
Background:
- Intensive care units (ICUs) in Nepal face challenges with antibiotic utilization.
- Antimicrobial resistance is a growing global health concern, exacerbated by suboptimal antibiotic practices.
Purpose of the Study:
- To investigate antibiotic use prevalence and practices in Nepalese ICUs.
- To identify opportunities for implementing antimicrobial stewardship programs.
Main Methods:
- A point prevalence survey was conducted in level III ICUs across Nepal.
- Data collected included antibiotic prescription rates, reasons for use, prescribing practices, and antimicrobial resistance patterns.
Main Results:
- A high antibiotic prescribing rate of 92.85% was observed in ICUs.
- Prolonged surgical prophylaxis and empirical therapy were common, with poor adherence to guidelines.
- Widespread use of broad-spectrum antibiotics and high resistance rates against frequently used antimicrobials were noted.
Conclusions:
- There is an urgent need for antimicrobial stewardship programs in Nepalese ICUs.
- Implementing stewardship can optimize antibiotic use, improve patient outcomes, and combat antimicrobial resistance.
- Findings provide a basis for improving antibiotic prescribing in this setting.
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