Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use

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 met-ronidazole (17%) and gentamicin (10%). Pneumonia was the most common diagnosis among those prescribed anti-microbials 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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Automated summary

The prevalence of antimicrobial use among hospitalized patients in Laos is high, with frequent inappropriate use, especially for surgical prophylaxis. Continued monitoring and enhanced antimicrobial stewardship interventions are needed in Lao hospitals.