Category: Professional Posters
Purpose: Antimicrobial resistance (AMR) is a major public health concern . The use of antimicrobials to prevent and treat maternal and fetal infections is well established in obstetric practice. To the best of our knowledge, this is the first Point Prevalence Survey from the middle east that focused explicitly on antimicrobial use among obstetric and gynecologic patients. The primary objective of this study is to determine the prevalence of antibiotic utilization among patients in Women’s Wellness and Research Center (WWRC) and to describe the prescription pattern of antibiotic use in the largest tertiary care obstetric hospital in Qatar.
Methods: The study was carried out at WWRC, a tertiary care obstetric and gynecologic hospital in the state Qatar. In conjugation with the local Antimicrobial Stewardship Program, a point prevalence cross-sectional survey was conducted to quantify and characterize the antimicrobial utilization. The Global point prevalence survey protocol was adapted to evaluate the antimicrobial. Patients were identified through a stewardship integrated program built in the Cerner (electronic medical record) and the list of patients on antimicrobials were generated electronically. The data extraction tool was built according to the Global Point Prevalence Survey GPPS. The data collection was mainly around prevalence of antimicrobial use, patients’ clinical diagnosis and indications for antibiotic use (documented in the notes), class of antimicrobial (Anatomical Therapeutic Chemical (ATC) classification system from the World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology, route of administration, compliance to the guidelines (if the antimicrobial of choice was in accordance with the local, national or international guidelines), stop/review date documentation of antimicrobials, eligibility for intravenous (IV) to oral conversion and duration of therapy (from the point of initiation to discharge) etc. A specialized antimicrobial stewardship pharmacist (BT) performed retrospective data collection A specialized antimicrobial stewardship pharmacist performed retrospective data collection for one day of antimicrobial use. The study also calculated daily defined dose of antimicrobials used for 6 months.
Results: On the day of the survey a total of 202 patients were admitted in the hospital, of whom 40 patients (19.8%) were receiving one or more antimicrobial agents. In total, 120 medication orders (1 order is equivalent to one item) were dispensed, majority of which originated from labor and delivery unit (43.3%) followed by antenatal (21.7%), gynecologic unit (15%), postnatal (15%) and high dependency unit (5%). Antimicrobials were used more frequently for definitive (44%) treatment, whilst 29% of the antibiotics reported were given for prophylaxis and only a quarter (26%) of the antibiotic prescriptions was written empirically. Most common indication for antibiotic use (Figure 1) were Group B streptococcus (GBS) followed by surgical prophylaxis (17.5%) and septic miscarriage (14.2%). Nearly half (47.56%) of the patients were reported to have no microbial growth (blood/urine/nasal/vaginal swab) in the culture, Streptococcus Group B (25%) was the most prevalent organism found followed by Streptococcus agalactiae (7.5%) and Bacteroides fragilis (2.5%). Beta-lactamase sensitive penicillins (such as amoxicillin/ clavulanate) (30%) were the most frequently prescribed class of medications followed by First generation cephalosporin (eg. cefazolin). Over the five months, the total antibiotic consumption in terms of DDD/1000 patient days varied from 351.37 – 452.05 (IQR 107).
Conclusion: The study provides important updates to the use of antimicrobials at the largest obstetric hospital in Qatar and provides the largest data set across middle east in terms of antimicrobial use explicitly in obstetric population. Although the actual dosing of antibiotics prescribing seemed appropriate and compliant to the local or international guidance further studies including larger samples are required to have a clear picture. As majority of antimicrobials were used for surgical prophylaxis, there is also the need to further explore the factors contributing to the high prevalence of antibiotic use in surgeries.