Point prevalence survey of antibiotic use among hospitalized patients across 41 hospitals in Thailand

Suvaporn Anugulruengkitt; Lantharita Charoenpong; Anond Kulthanmanusorn; Varaporn Thienthong; Sang Usayaporn; Wanwisa Kaewkhankhaeng; Oranat Rueangna; Jiratchaya Sophonphan; Visal Moolasart; Weerawat Manosuthi; Viroj Tangcharoensathien

doi:10.1093/jacamr/dlac140

Point prevalence survey of antibiotic use among hospitalized patients across 41 hospitals in Thailand

JAC Antimicrob Resist. 2023 Jan 4;5(1):dlac140. doi: 10.1093/jacamr/dlac140. eCollection 2023 Feb.

Affiliations

¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.
³ Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
⁴ International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.
⁵ Division of International Disease Control Ports and Quarantine, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
⁶ Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
⁷ The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), the Thai Red Cross AIDS Research Centre, Bangkok, Thailand.

Abstract

Objectives: To describe the antibiotic use among hospitalized patients in Thailand.

Methods: A standardized cross-sectional point prevalence survey (PPS) modified from the WHO PPS protocol was conducted in 41 selected hospitals in Thailand. All inpatients who received an antibiotic at 9 a.m. on the survey date were enrolled. The total number of inpatients on that day was the denominator.

Results: Between March and May 2021, a total of 8958 inpatients were enumerated; 4745 inpatients received antibiotics on the day of the survey and there were 6619 prescriptions of antibiotics. The prevalence of antibiotic use was 53.0% (95% CI 51.1%-54.0%), ranging from 14.3% to 73.4%. The antibiotic use was highest among adults aged >65 years (57.1%; 95% CI 55.3%-58.9%). From 6619 antibiotics prescribed, 68.6% were used to treat infection, 26.7% for prophylaxis and 4.7% for other or unknown indications. Overall, the top three commonly used antibiotics were third-generation cephalosporins (1993; 30.1%), followed by first-generation cephalosporins (737; 11.1%) and carbapenems (703; 10.6%). The most frequently used antibiotics for community-acquired infections were third-generation cephalosporins (36.8%), followed by β-lactam/β-lactamase inhibitors (11.8%) and carbapenems (11.3%) whereas for the patients with hospital-acquired infections, the most common antibiotics used were carbapenems (32.7%), followed by β-lactam/β-lactamase inhibitors (15.7%), third-generation cephalosporins (11.7%) and colistin (11.7%). The first-generation cephalosporins were the most commonly used antibiotics (37.7%) for surgical prophylaxis. Seventy percent of the patients received surgical prophylaxis for more than 1 day post surgery.

Conclusions: The prevalence of antibiotic use among hospitalized patients in Thailand is high and one-quarter of these antibiotics were used for prophylaxis. The majority of surgical prophylaxis was inappropriately used for a long duration post operation. Therefore, it is recommended that local guidelines should be developed and implemented.