Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey
Abstract
:- Inappropriate use of antimicrobials in hospitals is widely reported.
- In Jordan, understanding of antimicrobial consumption patterns is required to support recent policy intentions.
- Our results add to WHO’s recent efforts to understand the prevalence of infections and antibiotic consumption in low- and middle-income countries.
- Evaluation of both the quality and quantity of prescribed antimicrobial agents may enhance the improvement of their prescribing patterns. This could be achieved through positively changing the education and prescribing practices, mainly in countries that lack appropriate tools, including ours, to monitor antibiotic prescribing in hospitals.
- The results of the Global Point Prevalence Survey will allow sharing of best practice, raise awareness of inappropriate antimicrobial prescribing to improve the prescribing of antibiotic at hospital level.
- Governments can utilise this data to provide a base for antimicrobial stewardship programs.
1. Introduction
2. Methods
2.1. Study Design, Setting, and Ethics
2.2. Data Collection
2.3. Data Analysis
3. Results
3.1. Prevalence of Prescribing Antimicrobial Agents
3.2. Prevalence of Healthcare-Associated Infections
3.3. Indications for Antimicrobial Prescribing
3.4. Prescription Patterns of Antimicrobial Agents
3.5. Quality Indicators and Prescription Patterns of Antimicrobial Agents
3.6. Resistance Patterns
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Data Availability
References
- Cassini, A.; Högberg, L.D.; Plachouras, D.; Quattrocchi, A.; Hoxha, A.; Simonsen, G.S.; Colomb-Cotinat, M.; Kretzschmar, M.E.; Devleesschauwer, B.; Cecchini, M.; et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A populationlevelmodelling analysis. Lancet Infect. Dis. 2019, 19, 56–66. [Google Scholar] [CrossRef] [Green Version]
- Antonanzas, F.; Goossens, H. The economics of antibiotic resistance: A claim for personalised treatments. Eur. J. Health Econ. 2019, 20, 483–485. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bell, B.G.; Schellevis, F.; Stobberingh, E.; Goossens, H.; Pringle, M. A systematic review and metaanalysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect. Dis. 2014, 14, 13. [Google Scholar] [CrossRef] [Green Version]
- Laxminarayan, R.; Matsoso, P.; Pant, S.; Brower, C.; Røttingen, J.A.; Klugman, K.; Davies, S. Access to effective antimicrobials: Aworldwide challenge. Lancet 2016, 387, 168–175. [Google Scholar] [CrossRef]
- Hammour, K.A.; Jalil, M.A.; Hammour, W.A. An exploration of parents’ knowledge, attitudes and practices towards the use of antibiotics in childhood upper respiratory tract infections in a tertiary Jordanian Hospital. Saudi Pharm. J. 2018, 26, 780–785. [Google Scholar] [CrossRef] [PubMed]
- Hammour, K.A.; Farha, R.A.; Alsous, M.; Rizik, M.; Hammour, W.A. Evaluation of risk factors affecting parental knowledge and attitude toward antibiotic use in children with upper respiratory tract infections. Eur. J. Integr. Med. 2018, 17, 107–111. [Google Scholar] [CrossRef]
- Al-Saleh, S.; Abu Hammour, K.; Abu Hammour, W. Influencing factors of knowledge, attitude, and practice regarding antibiotic use in children with upper respiratory tract infections in Dubai. J. Eval. Clin. Pract. 2020, 26, 197–202. [Google Scholar] [CrossRef]
- Hammour, K.A.; Al-Saleh, S.; Hammour, W.A. Parental views of antibiotic use in children with upper respiratory tract infections in Dubai. Eur. J. Integr. Med. 2019, 29, 100917. [Google Scholar] [CrossRef]
- Laxminarayan, R.; Chaudhury, R.R. Antibiotic resistance in India: Drivers and opportunities for action. PLoS Med. 2016, 13, e1001974. [Google Scholar] [CrossRef] [Green Version]
- Jinks, T.; Lee, N.; Sharland, M.; Rex, J.; Gertler, N.; Diver, M.; Jones, I.; Jones, K.; Mathewson, S.; Chiara, F.; et al. A time for action: Antimicrobial resistance needs global response. Bull. World Health Organ. 2016, 94, 558. [Google Scholar] [CrossRef]
- Seale, A.C.; Gordon, N.C.; Islam, J.; Peacock, S.J.; Scott, J.A. AMR surveillance in low and middleincome settings—A roadmap for participation in the Global Antimicrobial Surveillance System(GLASS). Wellcome Open Res. 2017, 2, 92. [Google Scholar] [CrossRef] [PubMed]
- WHO. Global Action Plan on Antimicrobial Resistance. Available online: http://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/ (accessed on 3 September 2020).
- MacDougall, C.; Polk, R.E. Antimicrobial stewardship programs in health care systems. Clin. Microbiol. Rev. 2005, 18, 638–656. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- WHO. Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2016–2017. Available online: http://apps.who.int/iris/bitstream/10665/259744/1/9789241513449-eng.pdf?ua=1 (accessed on 7 February 2018).
- Available online: https://www.whocc.no/atc/structure_and_principles/ (accessed on 12 October 2009).
- Magill, S.S.; Edwards, J.R.; Beldavs, Z.G.; Dumyati, G.; Janelle, S.J.; Kainer, M.A.; Lynfield, R.; Nadle, J.; Neuhauser, M.M.; Ray, S.M.; et al. Prevalence of antimicrobial use in US acute care hospitals, May–September 2011. JAMA 2014, 312, 1438–1446. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- European Centre for Disease Prevention and Control. Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in European Acute Care Hospitals. 2011–2012. Available online: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf (accessed on 11 April 2018).
- Versporten, A.; Zarb, P.; Caniaux, I.; Gros, M.F.; Drapier, N.; Miller, M.; Jarlier, V.; Nathwani, D.; Goossens, H.; Koraqi, A.; et al. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: Results of an internet-based global point prevalence survey. Lancet Glob. Health 2018, 6, e619–e629. [Google Scholar] [CrossRef] [Green Version]
- Al-Zu’bi, E.; Bdour, S.; Shehabi, A.A. Antibiotic resistance patterns of mecA-positive Staphylococcus aureus isolates from clinical specimens and nasal carriage. Microb. Drug Resist. 2004, 10, 321–324. [Google Scholar] [CrossRef] [PubMed]
- Al-Bakri, A.G.; Al-Hadithi, H.; Kasabri, V.; Othman, G.; Kriegeskorte, A.; Becker, K. The epidemiology and molecular characterization of methicillin-resistant staphylococci sampled from a healthy Jordanian population. Epidemiol. Infect. 2013, 141, 2384–2391. [Google Scholar] [CrossRef]
- Herath, S.C.; Normansell, R.; Maisey, S.; Poole, P. Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst. Rev. 2018. [Google Scholar] [CrossRef]
- Poster Communication (E0033) during ECCMID 2018 Congress, Madrid, Spain, 21–24 April 2018. Available online: https://www.escmid.org/escmid_publications/escmid_elibrary/?q=Frenette&tx_solr%5Bfilter%5D%5B0%5D=author%253ACharles%2BFrenette (accessed on 30 April 2018).
- Schuts, E.C.; Hulscher, M.E.; Mouton, J.W.; Verduin, C.M.; Stuart, J.W.; Overdiek, H.W.; van der Linden, P.D.; Natsch, S.; Hertogh, C.M.; Wolfs, T.F.; et al. Current evidence on hospital antimicrobial stewardship objectives: A systematic review and meta-analysis. Lancet Infect. Dis. 2016, 16, 847–856. [Google Scholar] [CrossRef]
- Zarb, P.; Amadeo, B.; Muller, A.; Drapier, N.; Vankerckhoven, V.; Davey, P.; Goossens, H.; ESAC-3 Hospital Care Subproject Group; Metz-Gercek, S.; Jansens, H.; et al. Identification of targets for quality improvement in antimicrobial prescribing: The web-based ESAC point prevalence survey 2009. J. Antimicrob. Chemother. 2011, 66, 443–449. [Google Scholar] [CrossRef] [Green Version]
- Elhajji, F.D.; Al-Taani, G.M.; Anani, L.; Al-Masri, S.; Abdalaziz, H.; Su’ad, H.; Al Bawab, A.Q.; Scott, M.; Farren, D.; Gilmore, F.; et al. Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan. BMC Health Serv. Res. 2018, 18, 849. [Google Scholar] [CrossRef] [Green Version]
- Bratzler, D.W.; Houck, P.M. Antimicrobial prophylaxis for surgery: An advisory statement fromthe National Surgical Infection Prevention Project. Clin. Infect. Dis. 2004, 38, 1706–1715. [Google Scholar] [CrossRef] [PubMed]
- De Jonge, S.W.; Gans, S.L.; Atema, J.J.; Solomkin, J.S.; Dellinger, P.E.; Boermeester, M.A. Timing of preoperative antibiotic.prophylaxis in 54,552 patients and the risk of surgical site infection: A systematic. review and meta-analysis. Medicine 2017, 96, e6903. [Google Scholar] [CrossRef] [PubMed]
- Ban, K.A.; Minei, J.P.; Laronga, C.; Harbrecht, B.G.; Jensen, E.H.; Fry, D.E.; Itani, K.M.; Dellinger, E.P.; Ko, C.Y.; Duane, T.M. Executive summary of the American College of Surgeons/Surgical Infection Society surgical site infection guidelines—2016 update. Surg. Infect. 2017, 18, 379–382. [Google Scholar] [CrossRef] [PubMed]
- Jalil, M.H.; Hammour, K.A.; Alsous, M.; Awad, W.; Hadadden, R.; Bakri, F.; Fram, K. Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors. Sci. Rep. 2017, 7, 1–9. [Google Scholar]
- Jalil, M.H.; Hammour, K.A.; Alsous, M.; Hadadden, R.; Awad, W.; Bakri, F.; Fram, K. Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries. Am. J. Infect. Control 2018, 46, 14–19. [Google Scholar] [CrossRef]
Diagnosis * | Patients (n = 125) | % |
---|---|---|
Pneumonia or lower respiratory tract infection | 28 | 22.4 |
Skin and soft tissue | 18 | 14.4 |
Upper urinary tract infection | 15 | 12.0 |
Bone joint infections | 14 | 11.2 |
Lower urinary tract infection | 11 | 8.8 |
Intraabdominal sepsis | 6 | 4.8 |
Other | 6 | 4.8 |
Gastrointestinal infections | 5 | 4.0 |
Bacteraemia | 4 | 3.2 |
Infection of central nervous system | 4 | 3.2 |
Overall Proportional Antibiotic Use | Medical Patients (110 Prescriptions) | Surgery Patients (109 Prescriptions) | Adult ICU Patients (47 Prescriptions) | Paediatric ICU Patients (6 Prescriptions) | Neonatal ICU Patients (13 Prescriptions) |
---|---|---|---|---|---|
Other beta-lactams | 46.4% | 62.4% | 34.0% | 50.0% | 7.7% |
Other antibacterials | 18.2% | 23.9% | 27.7% | 33.0% | 23.1% |
Penicillins | 14.5% | 7.3% | 12.8% | 38.5% | |
Sulfonamides and Trimethoprim | 2.1% | ||||
Macrolides Lincosamides and Streptogramins | 4.5% | 3.7% | 2.1% | 16.7% | |
Quinolones | 11.8% | 8.5% | |||
Tetracyclines | 1.8% | 6.4% | |||
Aminoglycosides | 4.5% | 0.9% | 6.4% | 30.8% |
Quality Indicator | Overall (197 Patients on 285 Antibiotics) | Medical (75 Patients on 110 Antibiotics) | Surgical (86 Patients on 109 Antibiotics) | ICU (36 Patients, 66 Antibiotics) |
---|---|---|---|---|
Indication recorded | 180 (63.2%) | 60 (54.5%) | 61 (56.0%) | 59 (89.4%) |
Stop/review date documented | 24 (8.4%) | 8 (7.3%) | 12 (11.0%) | 4 (6.1%) |
Guidelines missing | 12 (4.2%) | 5 (4.5%) | 7 (6.4%) | 0 (0%) |
Guideline compliant | 138/187 (73.8%) | 55/65 (84.6%) | 46/76 (60.5%) | 37/46 (80.4%) |
Intravenous route of administration | 191 (97.0%) | 71 (94.7%) | 85 (98.8%) | 35 (97.2%) |
Multiple ATB diagnosis * | 72/205 (35.1%) | 28/78 (35.9%) | 22/87 (25.3%) | 22/40 (55.0%) |
Multiple ATB patient ** | 71 (46.2%) | 27 (36.0%) | 23 (26.7%) | 24 (66.7%) |
Targeted prescribing *** | 41/191 (21.5%) | 16/90 (17.8%) | 31/51 (25.5%) | 12/50 (24.0%) |
Resistance Type | N Patients | Prevalence (%) |
---|---|---|
MRSA | 9 | 7.1 |
MRCoNS | 4 | 3.2 |
VRE | 0 | 0.0 |
ESBL | 5 | 4.0 |
3−ceph | 4 | 3.2 |
CRE | 0 | 0.0 |
ESBL−NF | 1 | 0.8 |
CR−NF | 2 | 1.6 |
Other MDR | 11 | 8.7 |
Overall resistance prevalence | 33 | 26.0 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Abu Hammour, K.; AL-Heyari, E.; Allan, A.; Versporten, A.; Goossens, H.; Abu Hammour, G.; Manaseer, Q. Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey. Antibiotics 2020, 9, 598. https://doi.org/10.3390/antibiotics9090598
Abu Hammour K, AL-Heyari E, Allan A, Versporten A, Goossens H, Abu Hammour G, Manaseer Q. Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey. Antibiotics. 2020; 9(9):598. https://doi.org/10.3390/antibiotics9090598
Chicago/Turabian StyleAbu Hammour, Khawla, Esraa AL-Heyari, Aya Allan, Ann Versporten, Herman Goossens, Ghayda’ Abu Hammour, and Qusai Manaseer. 2020. "Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey" Antibiotics 9, no. 9: 598. https://doi.org/10.3390/antibiotics9090598