Investigating the WHO's AWaRe classification for assessing antimicrobial stewardship programs: A single-center study.

Area of Science:

• Antimicrobial stewardship
• Pharmacology
• Public Health

Background:

• The World Health Organization (WHO) proposed the AWaRe (Access, Watch, Reserve) classification to aid antimicrobial stewardship programs (ASPs).
• Increased antibiotic use for non-infectious conditions may compromise the effectiveness of AWaRe in assessing ASPs.
• This study evaluates antimicrobial usage patterns based on AWaRe classification to identify challenges in ASP assessment.

Purpose of the Study:

• To evaluate antimicrobial usage patterns categorized by the AWaRe classification.
• To identify specific challenges and limitations in using the AWaRe classification for assessing antimicrobial stewardship programs (ASPs).

Main Methods:

• A retrospective study was conducted in an 845-bed hospital.
• Outpatient antimicrobial usage data were extracted from medical billing records.
• Non-infectious antimicrobial use was defined by specific agents and dosages, including macrolides, tetracyclines, rifaximin, and sulfamethoxazole-trimethoprim (ST).

Main Results:

• Antimicrobials for non-infectious treatment increased significantly, from 25.3% to 50.1% (amount/DDD) and 46.3% to 65.9% (prescription days) between January 2015 and March 2024.
• Usage of prophylactic ST agents rose 2.4-fold, and rifaximin increased over 100-fold.
• Excluding non-infectious use, the 'Access' category ratios increased from 31.9% to 58% (amount/DDD) and 42% to 78% (prescription days).

Conclusions:

• The AWaRe classification may not be suitable for assessing and comparing antimicrobial stewardship programs (ASPs) across different healthcare settings.
• The rise in non-infectious antibiotic use complicates the accurate evaluation of ASPs using the current AWaRe framework.