Global point prevalence survey in five teaching hospitals in Baghdad, Iraq

Abstract: Introduction: One of the crucial steps of the antimicrobial stewardship process is the measurement of antimicrobial usage. This study aims to assess the antimicrobial prescription patterns in Iraqi hospitals by conducting a survey and to determine quality indicators in order to establish an effective antimicrobial stewardship program in Iraq. Materials and Methods: A point prevalence survey (PPS) was undertaken in the five main teaching hospitals in Baghdad, Iraq. The survey included all patients admitted to hospitals on the day of the survey. The study pursued comprehensive data on patients who received antimicrobial therapy on the day of the survey. Results: Among the 808 included inpatients, 66.7% were treated with at least one antimicrobial agent. The neonatal intensive care unit had the highest antimicrobial prescription rate (97.2%), whereas the adult intensive care units had the lowest rate (41.7%). Half of the antibiotics prescribed were used for surgical and medical prophylactic indications. Third-generation cephalosporin, particularly ceftriaxone, was the most commonly used antibiotic (31.5%) for all types of indications, and vancomycin and meropenem were the most prescribed antibiotics in cases of sepsis (32% each). Approximately 98.8% of the prescribed antibiotics were employed for empiric uses. No applied institutional guidelines were applied in the treatment of any indicated infectious diseases. The majority of the antibiotics used were administered parenterally. Culture sensitivity tests were only conducted on 10 (1.2%) patients. Conclusion: The present study revealed several quality indicators that need improvement, including excessive prescription of prophylactic antibiotics in Iraqi hospitals and extremely high empiric use of antibiotics. The Global-PPS tool provides data that will help Iraq's health authorities in designing an action plan to improve the appropriate prescription of antimicrobial agents