Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey.

To delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes. Cross-sectional analytical study. Six referral hospitals in Tanzania. Patients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected. We analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics. Approximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results. Empirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.

使用世界卫生组织现患率调查（PPS）方法描述坦桑尼亚6家转诊医院抗菌药物使用的流行情况及相关因素，为医院特定的抗菌药物管理计划提供信息。 横断面分析研究。 坦桑尼亚的6家转诊医院。 2019年12月，调查期间每天8点前入住6家转诊医院病房的所有年龄和性别患者（n = 948）均被纳入研究。使用世界卫生组织PPS方法，收集医院、病房、患者、抗生素及抗生素使用指征的数据。 我们分析了按转诊医院、病房、指征和患者特征划分的抗生素使用流行率作为主要结果。我们还描述了对坦桑尼亚标准治疗指南（STG）以及世界卫生组织抗生素分类（AWaRe）的依从性。 约62.3%的住院患者使用了抗生素，主要是来自可及类抗生素（头孢曲松、甲硝唑或氨苄西林 - 氯唑西林）。抗生素处方对坦桑尼亚STG的总体依从性较高（84.0%），但塞古·杜尔地区转诊医院（68.0%）和马维尼地区转诊医院（57.8%）除外。抗生素处方最常见的指征是社区获得性感染（39.8%）。2岁以下儿童（比值比1.73，95%置信区间1.02 - 2.92，p = 0.039）；入住外科病房（比值比4.90，95%置信区间2.87 - 8.36，p <0.001）；以及入住儿科病房（比值比3.93，95%置信区间2.16 - 7.15，p <0.001）与抗生素使用几率增加有关。591名患者中只有2名是根据培养和抗菌药物敏感性试验结果使用抗生素的。 经验性使用抗生素很常见，可及类抗生素主要用于2岁以下儿童以及入住外科和儿科病房的患者。这些医院缺乏抗菌药物敏感性试验服务的利用，需要紧急干预。建议将抗生素使用的常规监测作为坦桑尼亚抗生素管理计划的一部分。