Antimicrobial prescribing in referral hospitals in Timor-Leste: results of the first two national point prevalence surveys, 2020-21.

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-08-01 DOI:10.1093/jacamr/dlae123
Guilherme Ximenes, Sajal K Saha, Helio Guterres, Adriano Vieira, Lisa Harris, Michelle Mahony, Agata Dos Santos, Lucia Toto, Elfiana Amaral, Jessie C Spargo, Sze Yen Tay, Salvador Amaral, Karen Champlin, Anthony D K Draper, Joshua R Francis, Jennifer Yan, Sarah A Lynar
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Abstract

Objectives: To describe antimicrobial use (AMU) in patients admitted to hospitals in Timor-Leste.

Methods: In 2020 and 2021, we undertook antimicrobial prescribing point prevalence surveys across all six hospitals in Timor-Leste (one national and five municipal) to describe AMU and appropriateness in admitted patients.

Results: In 2020, 291/394 (73.9%) surveyed patients had been prescribed antimicrobials, compared with 260/403 (64.5%) in 2021 (P = 0.004). Most (309/551; 56.1%) were prescribed one antimicrobial, and 179/551 (32.5%) were prescribed two. The most commonly prescribed antibiotics were ceftriaxone (38.5% in 2020, 41.5% in 2021) and ampicillin (35.7% in 2020, 32.3% in 2021), followed by gentamicin, metronidazole and cloxacillin. Reserve antibiotics like meropenem and vancomycin were minimally used. Of all antimicrobial prescriptions, 70.8% were deemed appropriate in 2020 and 69.1% in 2021. Antimicrobial prescriptions for surgical and post-partum prophylaxis were frequently deemed inappropriate [37/50 (74.0%) and 39/44 (88.6%) prescriptions, respectively].

Conclusions: Most patients admitted to hospital in Timor-Leste are prescribed antimicrobials, and approximately one-third of these prescriptions are inappropriate. However, this was in the context of limited local guideline availability at the time of surveys and limited microbiological culture capacity outside of the capital, Dili. Improved microbiological guidance, iterative guideline revisions based on local antimicrobial resistance (AMR) surveillance data, and enhanced stewardship activities including further point prevalence studies, could improve antimicrobial use, optimize patient outcomes and reduce AMR in Timor-Leste.

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东帝汶转诊医院的抗菌药物处方:2020-21 年前两次全国点流行率调查结果。
目的:描述东帝汶医院住院病人的抗菌药物使用情况(AMU):描述东帝汶医院住院病人的抗菌药物使用情况(AMU):2020年和2021年,我们在东帝汶所有六家医院(一家国立医院和五家市立医院)开展了抗菌药物处方点流行率调查,以描述入院患者的抗菌药物使用情况和适当性:2020年,291/394(73.9%)名接受调查的患者开具了抗菌药物处方,而2021年为260/403(64.5%)人(P = 0.004)。大多数患者(309/551;56.1%)处方了一种抗菌药,179/551(32.5%)处方了两种抗菌药。最常处方的抗生素是头孢曲松(2020 年为 38.5%,2021 年为 41.5%)和氨苄西林(2020 年为 35.7%,2021 年为 32.3%),其次是庆大霉素、甲硝唑和氯唑西林。美罗培南和万古霉素等备用抗生素的使用率极低。在所有抗菌药物处方中,2020 年有 70.8%被认为是适当的,2021 年为 69.1%。用于手术和产后预防的抗菌药物处方经常被认为是不适当的[分别为 37/50 (74.0%) 和 39/44 (88.6%)]:结论:在东帝汶,大多数住院病人都会被开具抗菌药物处方,其中约三分之一的处方是不恰当的。然而,在调查时,当地提供的指南有限,首都帝力以外的微生物培养能力也有限。在东帝汶,根据当地抗菌药物耐药性(AMR)监测数据改进微生物指导、反复修订指导原则以及加强监管活动(包括进一步的点流行率研究),可以改善抗菌药物的使用、优化患者的治疗效果并减少 AMR。
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CiteScore
5.30
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审稿时长
16 weeks
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