Study finds high broad-spectrum antibiotic use in Indonesian hospitals
A point-prevalence study (PPS) conducted in six Indonesian hospitals found a high rate of empirical use of broad spectrum antibiotics, researchers reported today in JAC-Antimicrobial Resistance.
The hospital-wide PPS was conducted at six hospitals in Jakarta from March 2019 to August 2019. Eligible patients included everyone who received one or more antimicrobials on the day of the survey or surgical prophylaxis less than 24 hours prior to the survey. The analysis focused on antibiotics for systemic use, and researchers classified antibiotics according to the World Health Organization's AWaRe (Access, Watch, and Reserve) classification system.
Of 1,602 hospitalized patients on the day of the survey, 993 (62%) received one or more antimicrobial, and of the 1,666 antimicrobial prescriptions, 1,273 (76.4%) were antibiotics. Antimicrobial use was highest in patients in intensive care units (86.8%), followed by surgical wards (66%), mixed medical-surgical wards (65%), and medical wards (51.4%). The most common prescribing reasons were pneumonia (27.7%), skin and soft-tissue infections (8.3%), and gastrointestinal prophylaxis (7.9%).
The most prescribed antibiotic classes were third-generation cephalosporins (44.3%), fluoroquinolones (13.5%), carbapenems (7.4%), and penicillins with beta-lactamase inhibitor (6.8%). According to the AWaRe classification, Watch antibiotics—broad-spectrum agents with an increased risk of developing resistance—accounted for 67.4% of antibiotics prescribed, while Access antibiotics accounted for 28% and Reserve antibiotics accounted for 2.4%. This pattern was similar across indications and ward types.
The researchers also found that hospital antibiotic guidelines were not available for 28.1% of prescriptions, and, when they were available, compliance was only 52.2%. In addition, the reason for the antibiotic prescription, the stop/review date, and the planned duration were poorly documented.
The authors note that the proportion of inpatients receiving antimicrobials in the study was significantly higher than has been reported in global PPS datasets.
"In conclusion, we observed high levels of parenteral, empirical use of broad-spectrum antibiotics in Indonesian hospitals, and inadequate performance on key quality indicators of prescribing," the study authors wrote. "Despite important progress in AMS [antimicrobial stewardship], supported by national policies, the study findings highlighted the need to strengthen AMS to increase use of narrower-spectrum antibiotics through culture-guided, targeted treatment and hospital guideline compliance."
Apr 26 JAC-Antimicrob Resist study
Measles infects 2 children in Connecticut household
Connecticut's Department of Public Health (CDPH) recently reported two measles cases in a Fairfield County household, the first of which was linked to international travel.
State officials reported the first case on Apr 9, which involved a child who wasn't yet vaccinated against measles and contracted the infection during international travel. On Apr 23, it reported a second case in a child from the household. The CDPH said it is working with local partners to identify contacts and implement control measures and that the cases mark the state's first measles reports since 2019.
In most places in the world, measles cases have been much lower than usual, likely due to reduced travel and COVID-19 restrictions. In 2020, the US Centers for Disease Control and Prevention (CDC) reported 13 cases, down dramatically from 1,282 reported in 2010. As of Mar 5, the CDC hadn't received any reports of measles cases for 2021. Last month Doctors Without Borders (MSF) warned about widespread measles activity in the Democratic Republic of Congo, and global health officials have warned of a possible resurgence due to a pandemic-related lapses in routine childhood immunizations.
Apr 9 CDPH statement
Apr 23 CDPH statement
CDC measles page
Mar 31 MSF statement
H5 avian flu strikes poultry in Slovakia and Bulgaria
Two European countries recently reported new highly pathogenic H5 avian influenza outbreaks in poultry, including the first involving H5N1 in Slovakia, according to the latest notifications from the World Organization for Animal Health (OIE).
Slovakia's outbreak began Apr 21 at a small backyard holding in Bratislava region in the far west of the country. The virus killed all six of six susceptible hens. Investigators said wild birds probably introduced the virus into the flock.
Earlier H5N1 detections in European poultry have involved the Eurasian strain, not the strain that has caused human infections.
Elsewhere, Bulgaria reported an H5 outbreak that began on Apr 22 at a layer farm in Haskovo province in the south of the country near the borders with Greece and Turkey. The virus killed 660 of 39,950 susceptible poultry.
Apr 22 OIE report on H5N1 in Slovakia
Apr 26 OIE report on H5 in Bulgaria