A multicentre point prevalence survey of hospital antibiotic prescribing and quality indices in the Kurdistan regional government of Northern Iraq: the need for urgent action

ABSTRACT

Background

Rationale antibiotic use is crucial to address antimicrobial resistance (AMR) threats. No study has been undertaken in the Kurdistan Regional Government (KRG) to document current antibiotic use/areas for improvement given the high AMR rates.

Research design and methods

Point prevalence survey (PPS), using the Global PPS methodology, was conducted among the three major public hospitals in KRG/northern Iraq from September–December 2019. Prevalence and quality of antibiotic use were assessed using agreed indicators.

Results

Prevalence of antibiotic use was high (93.7%; n = 192/205); third-generation cephalosporins were the most commonly prescribed antibiotics (52.6%; n = 140/266). Reasons for treatment were recorded for only 61.7% (n = 164/266) of antibiotics and high use (89.9%) of parenteral therapy was observed. All therapy was empirical, no stop/review dates were recorded, and no treatment guidelines were available. The majority of the prescribed antibiotics (62%; n = 165/266) were from the WHO Watch list.

Conclusion

Prevalence of antibiotic use was high not only versus other hospitals in the region but globally, coupled with significant evidence of sub-optimal prescribing. Swift action is needed to improve future prescribing to reduce AMR. One or two areas should initially be targeted for quality improvement including development of local guidelines, documentation of antibiotic indications, and/or stop/review dates.

KEYWORDS:

• Antimicrobial resistance
• antibiotic utilization patterns
• iraq
• kurdistan regional government
• point prevalence survey
• quality improvement programs

Article highlights

• Published data surrounding antibiotic prescribing in the Kurdistan Region of Iraq, an ethnically distinct and semi-autonomous region, are scarce.

• This study, for the first time, measured and assessed the pattern and quality of antibiotic use in adult inpatients among hospitals in the largest city in Kurdistan Region Government in Northern Iraq using the validated Global PPS methodology, an internationally recognized approach, to identify target areas for quality improvement to support rationale use of antibiotics.

• Our study findings revealed a very high prevalence of antibiotic prescribing, a predominance of intravenous and broad-spectrum antibiotic use, lack of antibiotic prescribing guidance, and poor documentation of both indication and planned review of treatment.

• These findings, therefore, indicate the need to develop local and national antimicrobial stewardship programs (ASPs) to improve the future rational use of antibiotics in order to optimize individual patient care and minimize the risk of AMR in Iraq and worldwide.

• Key target areas for ASPs include development of treatment guidelines and targeting 1-2 areas for quality improvement interventions such as documenting reasons for indications and stop/review dates to facilitate IV to oral switching, when appropriate.

Authors contribution

Study conception and design: all authors; data collection and management: A. Hasan, K. Baker, and Z. Razmi; data analysis and interpretation: A. Kurdi, B. Godman, R.A. Seaton, J. Sneddon; manuscript writing and drafting: A. Kurdi, B. Godman; manuscript reviewing and revising as well as providing constrictive criticism and final approval: all authors.

Acknowledgments

We would like to thank Awesar F. Ali, Barzi R. Hamasalih, Sara R. Mohammed Ain, Omer O. Rashid, and Nawroz F. Muhamad (final year nursing students at the College of Nursing, University of Sulaimani) for their help with the data collection.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed participation in the Global-PPS. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.