Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries
Authors: Pauwels Ines , Versporten Ann , Drapier Nico , Vlieghe Erika , Goossens Herman ,   the Global-PPS network, Koraqi Andi , Hoxha Iris , Tafaj Silva , Cornistein Wanda , Quiros Rodolfo , Hojman Martin , Ghazaryan Lilit , Horne Kylie , Cairns Kelly , Doukas Fiona , Gottlieb Thomas , Sermijn Erica , Verhamme Katia , Brands Christiane , Van Herendael Bruno , Filippin Lorenzo , Vandewal Wouter , Konopnicki Deborah , Maillart Evelyne , Teixeira Lopes Liliana , Papin Pauline , Smits Ilse , Jansens Hilde , Bartholomeus Sofie , Van den Abeele Anne-Marie , Steyaert Sophia , Piette Anne , Buyle Franky , Cartuyvels Reinoud , Jonckheere Stijn , Wybo Ingrid , Vanneste Lorenz , Mathieu Delphine , Firre Eric , Westelinck Veerle , Gadisseux Philippe , Dugernier Thierry , Bafort Kristof , Gonissen Viviane , Vanderper Vanessa , Gabriels Patrick , Weekers Frank , Michel Philippe , Van Liedekerke Ann , Costers Michiel , Catry Boudewijn , Dedeic-Ljubovic Amela , Gales Ana C , Matos Porto Ana Paula , Figueiredo Costa Silvia , Keuleyan Emma , Beidi Apollinaire , Cissohko Youssouph , Blakwe Habsatou , Batchaya Basile Ngassa , German Greg J , Lutes Sarah , Boswell Jennifer , Mertz Dominik , Nguyen Tuyen , MacLaggan Timothy , Landry Daniel , Ang Anita , Thirion Daniel J G , Frenette Charles , Émond Yannick , Roberts Jacqueline , Chang Sandra , Kosar Justin , Valiquette Louis , Dutrisac Ginette , Afra Kevin , McGeer Allison , Carrier Marie , Grant Jennifer , Labarca Jaime , Carvajal Camila , Lin HongYi , Wang Qiang , Yang Jing , Yang Wenjie , Cortes Jorge A , Villalobos-Vindas Juan , Ramírez-Valverde Carlos , Horvatic Jasminka , Pristas Irina , Paphitou Niki , Rummukainen Maija-Liisa , Froissart Antoine , Vanhems Philippe , Pagava Karaman , Korinteli Irma , Brandt Tobias , Gaertner Johannes , Enimil Anthony , Roilides Emmanuel , Hajdú Edit , Sengupta Sharmila , Singh Sanjeev , Patil Priyanka , Poojary Aruna , Soltani Jafar , Pouladfar Gholamreza , Jafarpour Zahra , Alinia Cyrus , Ameen Hadi , Fitzgerald David , Paul Mical , Maor Yasmin , Strahilevitz Jacob , Chowers Michal , Temkin Elizabeth , Luca Arnoldo , Ishibashi Noriomi , Gu Yoshiaki , Darwish Elhajji Feras , Karabukayeva Aizhan , Raka Denis , Kambaralieva Baktygul , Zarakauska Lelde , Zarb Peter , Hernandez Chena Blanca Estela , Gonzalez-Diaz Esteban , Corona-Meléndez JuanCarlos , Torres Erazo Darwin Stalin , Loza-Jalil Suria Elizabeth , Molina Julio , Candelas Jose Antonio , Mijovic Gordana , Duborija-Kovacevic Natasa , Jong Eefje , Kluytmans Jan , van Elzakker Erika , Schweitzer Valentijn , Davies Nicola , Iregbu Kenneth , Nwajiobi-Princewill Philip , Nwafia Ifeyinwa , Fasuyi Temitayo , Aboderin Aaron , Elikwu Charles John , Fadeyi Abayomi , Ola-Bello Olafoyekemi , Oduyebo Oyinlola , Adedosu Akin Nelson , Ekuma Agantem , Shaqiri Erjona , Saleem Zikria , De Los Reyes Mari Rose , Tavares Luis , Kim Nam Joong , Rachina Svetlana , Alharthi Alwaleed R , Enani Mushira , Faried Osama , Mirghani Mohamed , Carevic Biljana , Radulovic Lili , Dragovac Gorana , Tan Sock Hoon , Taljaard Jantjie , Chibabhai Vindana , Joiner Jennifer , Caston Juan Jose , Núñez-Núñez María , Martínez-Marcos Francisco Javier , Ojeda-Burgos Guillermo , Menendez Maria Dolores , Retamar Pilar , Corzo Juan E , Rattanaumpawan Pinyo , Salou Mounerou , Mnif Basma , Oncul Ahsen , Babigumira Peter Ahabwe , Olweny James , Marshall Emily , McCorry Ann , Aldeyab Mamoon , Khanna Priya , Gormley Cairine , Maloney Sara , Cooper Mandelin , Blackburn Laura , Gessner-Wharton Mallory , Vu Lam , Greer Nickie , Gawrys Gerard , Kronmann Lisha , Rios Edgar , Hudson Melissa , Lindholm David A 
Published: February 2021

Objectives

The WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population.

Methods

The Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed.

Results

Regional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). Reserve use ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America. There were large differences in AWaRe prescribing at country level. Watch antibiotics were prescribed for a range of very different indications worldwide, both for therapeutic and prophylactic use.

Conclusions

We observed considerable variations in AWaRe prescribing and high use of Watch antibiotics, particularly in lower- and upper-middle-income countries, followed by high-income countries. The WHO AWaRe classification has an instrumental role to play in local and national stewardship activities to assess prescribing patterns and to inform and evaluate stewardship activities.