Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey

Global-PPS network, Ann Versporten, Peter Zarb, Isabelle Caniaux, Marie Françoise Gros, Nico Drapier, Mark Miller, Vincent Jarlier, Dilip Nathwani, Herman Goossens, Andi Koraqi, Iris Hoxha, Silva Tafaj, Denada Lacej, Martin Hojman, Rodolfo Ernesto Quiros, Lilit Ghazaryan, Kelly A. Cairns, Allen Cheng, Kylie C. Horne & 31 others Fiona F. Doukas, Thomas Gottlieb, Jameela Alsalman, Koen Magerman, Gounongbe YT Marielle, Amela Dedeic Ljubovic, André Afonso Machado Coelho, Ana Cristina Gales, Emma Keuleyan, Deana Sabuda, Jennifer Lee Boswell, John M. Conly, Alvaro Rojas, Camila Carvajal, Jaime Labarca, Antonio Solano, Carlos Ramírez Valverde, Juan M. Villalobos-Vindas, Irina Pristas, Vanda Plecko, Niki Paphitou, Erjona Shaqiri, Maija Liisa Rummukainen, Karaman Pagava, Irma Korinteli, Tobias Brandt, Sabine Messler, Anthony Enimil, Elias Iosifidis, Emmanuel Roilides, Mamoon A. Aldeyab

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Abstract

Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux.

LanguageEnglish
Pagese619-e629
Number of pages11
JournalThe Lancet Global Health
Volume6
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

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Internet
Inpatients
Anti-Bacterial Agents
Prescriptions
Latin America
Guidelines
Central Asia
Carbapenems
Pediatric Hospitals
Medical Oncology
Far East
Surveys and Questionnaires
United Nations
Fluoroquinolones
Hematology
Cephalosporins
Therapeutics
Critical Care
Microbial Drug Resistance
Cross Infection

Cite this

@article{7d3df6a2a9974fcab9513726d9d27afc,
title = "Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey",
abstract = "Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4{\%}) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3{\%}) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8{\%}) received a targeted antibacterial treatment for systemic use, and 1769 (5·9{\%}) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9{\%}]) and east and south Asia (5363 [10·1{\%}]). Overall, the reason for treatment was recorded in 31 694 (76·9{\%}) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3{\%}). Local antibiotic guidelines were missing for 7050 (19·2{\%}) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4{\%}. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioM{\'e}rieux.",
author = "{Global-PPS network} and Ann Versporten and Peter Zarb and Isabelle Caniaux and Gros, {Marie Fran{\cc}oise} and Nico Drapier and Mark Miller and Vincent Jarlier and Dilip Nathwani and Herman Goossens and Andi Koraqi and Iris Hoxha and Silva Tafaj and Denada Lacej and Martin Hojman and Quiros, {Rodolfo Ernesto} and Lilit Ghazaryan and Cairns, {Kelly A.} and Allen Cheng and Horne, {Kylie C.} and Doukas, {Fiona F.} and Thomas Gottlieb and Jameela Alsalman and Koen Magerman and Marielle, {Gounongbe YT} and Ljubovic, {Amela Dedeic} and Coelho, {Andr{\'e} Afonso Machado} and Gales, {Ana Cristina} and Emma Keuleyan and Deana Sabuda and Boswell, {Jennifer Lee} and Conly, {John M.} and Alvaro Rojas and Camila Carvajal and Jaime Labarca and Antonio Solano and Valverde, {Carlos Ram{\'i}rez} and Villalobos-Vindas, {Juan M.} and Irina Pristas and Vanda Plecko and Niki Paphitou and Erjona Shaqiri and Rummukainen, {Maija Liisa} and Karaman Pagava and Irma Korinteli and Tobias Brandt and Sabine Messler and Anthony Enimil and Elias Iosifidis and Emmanuel Roilides and Aldeyab, {Mamoon A.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1016/S2214-109X(18)30186-4",
language = "English",
volume = "6",
pages = "e619--e629",
journal = "The Lancet Global Health",
issn = "2214-109X",
publisher = "Elsevier BV",
number = "6",

}

TY - JOUR

T1 - Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries

T2 - The Lancet Global Health

AU - Global-PPS network

AU - Versporten, Ann

AU - Zarb, Peter

AU - Caniaux, Isabelle

AU - Gros, Marie Françoise

AU - Drapier, Nico

AU - Miller, Mark

AU - Jarlier, Vincent

AU - Nathwani, Dilip

AU - Goossens, Herman

AU - Koraqi, Andi

AU - Hoxha, Iris

AU - Tafaj, Silva

AU - Lacej, Denada

AU - Hojman, Martin

AU - Quiros, Rodolfo Ernesto

AU - Ghazaryan, Lilit

AU - Cairns, Kelly A.

AU - Cheng, Allen

AU - Horne, Kylie C.

AU - Doukas, Fiona F.

AU - Gottlieb, Thomas

AU - Alsalman, Jameela

AU - Magerman, Koen

AU - Marielle, Gounongbe YT

AU - Ljubovic, Amela Dedeic

AU - Coelho, André Afonso Machado

AU - Gales, Ana Cristina

AU - Keuleyan, Emma

AU - Sabuda, Deana

AU - Boswell, Jennifer Lee

AU - Conly, John M.

AU - Rojas, Alvaro

AU - Carvajal, Camila

AU - Labarca, Jaime

AU - Solano, Antonio

AU - Valverde, Carlos Ramírez

AU - Villalobos-Vindas, Juan M.

AU - Pristas, Irina

AU - Plecko, Vanda

AU - Paphitou, Niki

AU - Shaqiri, Erjona

AU - Rummukainen, Maija Liisa

AU - Pagava, Karaman

AU - Korinteli, Irma

AU - Brandt, Tobias

AU - Messler, Sabine

AU - Enimil, Anthony

AU - Iosifidis, Elias

AU - Roilides, Emmanuel

AU - Aldeyab, Mamoon A.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux.

AB - Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux.

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U2 - 10.1016/S2214-109X(18)30186-4

DO - 10.1016/S2214-109X(18)30186-4

M3 - Article

VL - 6

SP - e619-e629

JO - The Lancet Global Health

JF - The Lancet Global Health

SN - 2214-109X

IS - 6

ER -