Point Prevalence Survey of Antibiotic Prescriptions and Infection in Sanandaj Hospitals, a three Year Surveillance Study in Sanandaj, Iran

Background and Objectives: Point Prevalence Surveys (PPS) provide useful data on the patterns of in-hospital antimicrobial prescribing and is crucial for changing prescribing practices for antibiotic stewardship programs. Herein, antimicrobial prescribing patterns in various wards of 4 teaching hospitals in Sanandaj, west Iran, were studied to find targets for quality improvement. Methods: A 1-day PPS on antimicrobial use in hospitalized patients performed from January through March 2015, 2017, 2019 using a validated and standardized method based on the Global Point Prevalence study project (Global PPS) designed by Antwerp University, Belgium. We analyzed all hospitalized patients from 3 teaching hospitals (Besat, Tohid, and Kowsar hospitals) and one secondary general hospital (social security hospital). Various quality indicators compared in terms of the prevalence of antibiotic usages by hospital name and ward types, proportional usage of antibiotics, indication for usage, most common diagnosis, reason in notes, compliances to guidelines, and stop/review date documentations. Results: Out of 2358 admissions in all wards of the four hospitals in three years, 1351(57.3%) patients received at least one antimicrobial, varying considerably between the hospitals and wards and years of studies. The numbers for 1887, 325, and 146 admissions in adult, pediatric, and neonatal wards, were calculated as 990(52.4%), 254(78.1%), and 107(73.2%), respectively. The most commonly prescribed antibiotics were as follows: in adult wards ceftriaxone (19.3%), cefazolin (15.8%), Metronidazole (7.8), and ciprofloxacin (7.5%); in pediatric wards ceftriaxone (54.5%), vancomycin (9.4 %), meropenem (5.9%) and cefotaxime(5.1%); in neonatal wards ampicillin (38.1%) and cefotaxime (30.1%), vancomycin (9.6), and gentamycin (9.1). Antimicrobial combination therapies frequencies in adult, pediatric, and neonatal wards in the three year studies were 38.6%, 31.6%, and 95.7%, respectively. Empirical antibiotic therapies in adult, pediatric, and neonatal wards were 98.5%, 96.8%, and 98.4%, respectively.Conclusions: Data show a high deviation from standard antibiotic therapy in comparison to developed countries. Quality improvement in hospital antibiotic prescriptions is strongly needed. The high percentage of antimicrobial use, combination, and empirical therapies could target for quality improvement in our health centers.