Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey
Authors: 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, 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, Mamadou Saliou Sow, Sharmila Sengupta, Joby V George, Aruna Poojary, Priyanka Patil, Jafar Soltani, Zahra Jafarpour, Hadi Ameen, David Fitzgerald, Yasmin Maor, Michal Chowers, Elizabeth Temkin, Susanna Esposito, Luca Arnoldo, Silvio Brusaferro, Yoshiaki Gu, Feras Darwish El-Hajji, Nam Joong Kim, Baktygul Kambaralieva, Jana Pavare, Lelde Zarakauska, Vytautas Usonis, Sigita Burokiene, Inga Ivaskeviciene, Gordana Mijovic, Natasa Duborija-Kovacevic, Kristen Bondesio, Kenneth Iregbu, Oyinlola Oduyebo, Denis Raka, Lul Raka, Svetlana Rachina, Mushira Abdulaziz Enani, Mohamed Al Shehri, Biljana Carevic, Gorana Dragovac, Dusanka Obradovic, Aleksandra Stojadinovic, Lili Radulovic, Jia EN Wu, Gladys Wei Teng Chung, Hui Hiong Chen, Paul Anantharajah Tambyah, David Lye, Sock Hoon Tan, Tat Ming Ng, Hui Lin Tay, Moi Lin Ling, Maciej Piotr Chlebicki, Andrea L Kwa, Winnie Lee, Bojana Beović, Angela Dramowski, Heather Finlayson, Jantjie Taljaard, Guillermo Ojeda-Burgos, Pilar Retamar, Johan Lucas, Wolter Pot, Cees Verduin, Jan Kluytmans, Michael Scott, Mamoon A Aldeyab, Bernadette McCullagh, Cairine Gormley, David Sharpe, Mark Gilchrist, Laura Whitney, Matthew Laundy, Debbie Lockwood, Simon B Drysdale, Jennifer Boudreaux, Edward J Septimus, Nickie Greer, Gerard Gawrys, Edgar Rios, Suzanne May
Journal: The Lancet Global Health (2018)

BackgroundThe 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.MethodsWe 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.FindingsThe 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%.InterpretationThe 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.FundingbioMérieux.