Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use
Issued Date
2022-10-01
Resource Type
eISSN
26666065
Scopus ID
2-s2.0-85134765834
Journal Title
The Lancet Regional Health - Western Pacific
Volume
27
Rights Holder(s)
SCOPUS
Bibliographic Citation
The Lancet Regional Health - Western Pacific Vol.27 (2022)
Suggested Citation
Chansamouth V., Chommanam D., Roberts T., Keomany S., Paphasiri V., Phamisith C., Sengsavang S., Detleuxay K., Phoutsavath P., Bouthavong S., Douangnouvong A., Vongsouvath M., Rattana S., Keohavong B., Day N.P.J., Turner P., van Doorn H.R., Mayxay M., Ashley E.A., Newton P.N. Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use. The Lancet Regional Health - Western Pacific Vol.27 (2022). doi:10.1016/j.lanwpc.2022.100531 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85510
Title
Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Oxford University Clinical Research Unit
Ministry of Health Laos
London School of Hygiene & Tropical Medicine
Nuffield Department of Medicine
Salavan Provincial Hospital
Ministry of Health
Mahosot Hospital
Luang Namtha Provincial Hospital
Cambodia Oxford Medical Research Unit
Xiengkhuang Provincial Hospital
Vientiane Provincial Health Office
Savannakhet Provincial Hospital
Oxford University Clinical Research Unit
Ministry of Health Laos
London School of Hygiene & Tropical Medicine
Nuffield Department of Medicine
Salavan Provincial Hospital
Ministry of Health
Mahosot Hospital
Luang Namtha Provincial Hospital
Cambodia Oxford Medical Research Unit
Xiengkhuang Provincial Hospital
Vientiane Provincial Health Office
Savannakhet Provincial Hospital
Other Contributor(s)
Abstract
Background: Antimicrobial use (AMU) is a key driver of antimicrobial resistance (AMR). There are few data on AMU, to inform optimizing antibiotic stewardship, in the Lao PDR (Laos). Methods: Point prevalence surveys (PPS) of AMU were conducted at four-month intervals in six general hospitals across Laos from 2017 to 2020, using modified Global-PPS data collection tools. The surveys focused on AMU amongst hospitalized inpatients. Findings: The overall prevalence of inpatient AMU was 71% (4,377/6,188), varying by hospital and survey round from 50·4% (135/268) to 88·4% (61/69). Of 4,377 patients, 44% received >one antimicrobial. The total number of prescriptions assessed was 6,555. Ceftriaxone was the most commonly used (39·6%) antimicrobial, followed by metronidazole (17%) and gentamicin (10%). Pneumonia was the most common diagnosis among those prescribed antimicrobials in both children aged ≤5 years (29% among aged ≤1 year and 27% among aged >1 to ≤5years) and adults aged ≥15 years at 9%. The percentage of antimicrobial use compliant with local treatment guidelines was 26%; inappropriate use was mainly found for surgical prophylaxis (99%). Adult patients received ACCESS group antimicrobials less commonly than children (47% vs 63%, p-value<0·0001). Most WATCH group prescriptions (99%) were without a microbiological indication. Interpretation: AMU among hospitalized patients in Laos is high with frequent inappropriate use of antimicrobials, especially as surgical prophylaxis. Continued monitoring and enhanced antimicrobial stewardship interventions are needed in Lao hospitals. Funding: The Wellcome Trust [Grant numbers 220211/Z/20/Z and 214207/Z/18/Z] and bioMérieux.