Point Prevalence Survey of Antibiotic Use in Latin American Hospitals: 2022–2023

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Antimicrobial resistance (AMR) is one of the emerging public health threat in the world that is expected to cause more than 10 million deaths globally. Because of that global, regional and national action plans to reduce the AMR has been initiated.  Intensive surveillance of antibiotic usage in the human and animal community hospital settings is one the integral part of these action plans. In this context manuscript entitled “Point Prevalence Survey of antibiotic use in Latin American hospitals: 2022-2023” provides interesting data on antibiotic usage in selected countries of Latin America. Overall the manuscript is written well and provides valuable data. However the following revisions are needed before considering for publication.

 

Line no-45-The Latin American PPS aimed to provide a standardized -PPS need to be explained

 

Line no-70- contributed to 4.95 million -What does 4.95 million mean?

 

Line no- 140 - Antibiotics prescribed before the day of the survey or those prescribed but not administered the day of the survey were excluded-Based on what criteria they excluded

 

Line no-179- Ethics review -Approval number could be provided if available

 

Other big information missing in the methodology is –Weather these antibiotic prescriptions were made in the hospitals based on MIC/ABST data or Doctors empirical experience?   

 

Line no- 227-The Latin American PPS was conducted between March 2022 and November 2023. 186 Included 67 hospitals from five countries: Chile (13; n = 3339), Colombia (8; n = 1087), 187 Mexico (22; n = 2292), Panama (1; n = 298), and Peru (23; n = 4078). A total of 11,094  with CPGs, with higher 227-Why equal number of hospital inclusions were not taken as a criteria in each countries  

 

 

 Discussion – it would be better if the authors include the discussion regarding why doctors commonly prescribe following different categories of antibiotics (Cephalosporins,    carbapenems, glycopeptides and penicillin combinations) over other categories and their merits as well as risk of development of AMR for these drugs (if they are commonly used) as well as what are all the policy actions could be inferred from this study.

Author Response

Comment 1: Line no-45-The Latin American PPS aimed to provide a standardized -PPS need to be explained

Response 1: Explained PPS: Point prevalence survey of antimicrobials in the text.

Comment 2: Line no- 140 - Antibiotics prescribed before the day of the survey or those prescribed but not administered the day of the survey were excluded-Based on what criteria they excluded

Response 2: Added reference of PAHO PPS methodology. exclusion is based on the PPS methodology in the PAHO manual.

 

Comment 3: Line no-70- contributed to 4.95 million -What does 4.95 million mean?

Response 3: Thanks for detecting the mistake. It is 4.95 million deaths. I changed it in the paragraph

 

Commnent 4: Line no-179- Ethics review -Approval number could be provided if available

Response 4: Number added.  PAHOERC (PAHO-2018-10-0088) approved on November 7, 2018.

 

Comment 5: Other big information missing in the methodology is –Weather these antibiotic prescriptions were made in the hospitals based on MIC/ABST data or Doctors empirical experience?   

Response 5: Methodology explains that antimicrobial prescription is characterized as empiric or tailored and if its based on local guidelines or not. a supplement will include the questionnaire. In Methodology we reference the manuscript of our first PPS where we had supplements with details on methodology.

 

Comment 6: Line no- 227-The Latin American PPS was conducted between March 2022 and November 2023. 186 Included 67 hospitals from five countries: Chile (13; n = 3339), Colombia (8; n = 1087), 187 Mexico (22; n = 2292), Panama (1; n = 298), and Peru (23; n = 4078). A total of 11,094  with CPGs, with higher 227-Why equal number of hospital inclusions were not taken as a criteria in each countries .

Response 6: We placed in methodology. Hospitals were chosen by Ministries of health representatives of each Countries depending on their own needs/preferences. Since we are PAHO we can not choose hospitals with out the authorization from the officials.

Comment 7: Discussion – it would be better if the authors include the discussion regarding why doctors commonly prescribe following different categories of antibiotics (Cephalosporins,    carbapenems, glycopeptides and penicillin combinations) over other categories and their merits as well as risk of development of AMR for these drugs (if they are commonly used) as well as what are all the policy actions could be inferred from this study.

Results 7: 

Thanks for the recommendations. I changed the discussion and added some of resistance and info on the categories.  

Reviewer 2 Report

Comments and Suggestions for Authors

The authors conducted a Point Prevalence Survey (PPS) in 67 hospitals across five Latin American countries (Mexico, Chile, Peru, Colombia, and Panama) in 2022-2023. This is a very important study. The patient numbers and analyses are quite good. This is an important paper that will contribute to the literature.

Author Response

Dear Editor:

Thank you so much for your time to review the manuscript and your comments.

 

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript is well-written and is impactful, given the data from 67 hospitals. The use of the Spanish language modified version, as well as the inclusion of training and extension to three weeks, is commendable. However, a few suggestions remain as noted below:

• Methodology:
• Please add associated reasoning for exclusion criteria.
  • "The main differences included the exclusion of the McCabe score, and the criteria used to assess compliance with clinical practice guidelines (CPGs)."

  • Topical AB and those used to treat tuber- 144 culosis were excluded.

• Add to limitations: Since the hospitals were chosen based on their availability of resources (ethics committees as well as time/interest for participation in research studies), it should be mentioned in the limitations as it selectively excludes resource-limited hospitals that may have subpar compliance with guidelines for treatment and prophylaxis prescriptions. If this is the case, it may slow inflated compliance in the results. "Selected institutions were acute hospitalization centers of second or third level of care, with access to ethics committees for protocol approval, and interested in implementing the survey"
• Please include the appropriate time from "The survey should be completed during a period of three weeks (three weeks from?).

 

• Results:
• Table 6, stylistic suggestion would be to either bold or put a * next to the p-values to denote factors that are statistically significant for ease of reading.

 

• Discussion:
• The section seems less organized than other sections, with a lack of defined paragraphs and use of fly-away sentences. Please rewrite or recompile for better flow. 
• Add citations
• "The use of Reserve AB remains close to 5% in Colombia, Mexico and Chile. Similar 307 than those reported in the Global PPS, suggesting that the region has the highest preva- 308 lence of use among all regions worldwide."
• "On the other hand, hospitals from Chile, Mexico and Peru showed the largest pro- 310 portion of AB use from the Watch group, largely due to the use of third generation ceph- 311 alosporins."
• "According to comments made by members of the Mexican ASPs , the lack of availability of cefazolin in the country led to the use of ceftriaxone."

 

• Citations:
• Please ensure they are in the same citation style/format since a majority of them have come from reports, posters, websites, etc. 

Author Response

Comment 1: Methodology:

Thanks for the recommendation!. McCabe score was a non mandatory part of the WHO methodology . Because it was not going to be used in the analysis we decided to exclude it. Topical Ab excluded as part of the WHO methodology.

 

Comment 2: Table 6

Excellent recommendation! thanks. I added.

 

Comment 3: Discussion

I changed discussion. Check and see if flows better.

 

Thanks for your timing!

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have modified the manuscript according to the reviewers suggestions. Hence accepted.