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Antimicrobial Use at a Tertiary-Care Hospital in Türkiye According to the WHO Access, Watch and Reserve (AWaRe)
Muammer Çelik1, Ülker Uysal2, Aliye Çınar2
1Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University School of Medicine, İzmir, Türkiye - Infection Prevention and Control Committee, Dokuz Eylül University Research and Training Hospital, İzmir, Türkiye.
Objective:
Antimicrobial resistance (AMR) is a growing global threat, primarily driven by the inappropriate use of antibiotics. The World Health Organization (WHO) developed the Access, Watch, and Reserve (AWaRe) classification to guide antimicrobial stewardship by promoting the use of Access group antibiotics. This study aimed to evaluate both the quantitative and qualitative aspects of antibiotic use in a tertiary-care hospital in Türkiye, using a point prevalence methodology.
Materials And Methods:
A cross-sectional point prevalence survey was conducted at Dokuz Eylül University Hospital, a 1100-bed tertiary care center, on June 19-20, 2023. All inpatients were included except those in emergency, hemodialysis, or outpatient units. Data on demographics, infection risk factors, microbiological findings, and antibiotic use were collected. Appropriateness was assessed based on local guidelines and WHO AWaRe classification.
Results:
A total of 807 patients were surveyed; 48.9% (n=395) were receiving at least one antibiotic. Antibiotic use was highest in intensive care units (63.4%), followed by surgical (55.1%) and medical departments (41.6%). Therapeutic use accounted for 55.2% of prescriptions, and 79.3% were empirical. According to the AWaRe classification, 29% of antibiotics were categorized as Access, 65.9% as Watch, and 5.1% as Reserve. Inappropriate antibiotic use was identified in 43.9% of cases, primarily due to prescriptions without indication, inappropriate surgical prophylaxis, use of broad-spectrum empirical agents, and prolonged treatment duration.
Conclusion:
Antibiotic use in the hospital was high, with a predominance of Watch group agents and considerable inappropriate prescribing. Focused antimicrobial stewardship interventions are required to improve surgical prophylaxis, shorten treatment durations, reduce the empirical use of broad-spectrum antibiotics, and increase the utilization of Access group agents in line with WHO recommendations.
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