The point prevalence and inappropriateness of antibiotic use at hospitals in Turkey: a systematic review and meta-analysis

Abstract

Inappropriate antimicrobial use is a key problem causing antimicrobial resistance and increased health care costs. Although global point prevalence surveys on antimicrobial prescribing in hospitals were described, there is lack of data from Turkish hospitals. Here, we aimed to perform systematic review and meta-analysis for the point prevalence surveys on antimicrobial prescribing in Turkish hospitals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline was used to identify studies for the review. Articles published between January 2004 and September 2020 by Turkish investigators were included if they used the point prevalence survey method. The Joanna Briggs Institute’s critical appraisal tool and the World Health Organization’s point prevalence survey tool were used to the evaluate studies. Results were combined using random effects meta-analysis. The pooled point prevalence of antimicrobial use in Turkish hospitals was 48% (95% confidence interval 43–54). There was considerable heterogeneity in prevalence among the studies (I²= 98.75 %, 95 % CI 98.49-98-97). The most commonly prescribed antimicrobial and indication for antimicrobial use were third generation cephalosporins (36%) and respiratory tract infections (88%), respectively. More than two thirds of the antimicrobials were prescribed empirically (median: 71% [interquartile range: 56–80]) in hospitals. The point prevalence and inappropriateness of antimicrobial use are high in Turkish hospitals. Turkey is one of the biggest consumers of antimicrobials. There is an urgent need for antimicrobial stewardship programmes at Turkish hospitals to improve antimicrobial prescribing. Our study findings can contribute to improving antimicrobial prescribing, and thereby control antimicrobial resistance.

Keywords:

• point prevalence
• antibiotic use
• hospitals
• inappropriate antibiotics
• Turkey
• systematic review and meta-analysis

Acknowledgments

I would like to express my deepest gratitude to Assoc. Prof. Betul Okuyan for her help on data screening and evaluation.

Disclosure statement

The authors report no conflict of interest.

Authors contribution

AS and BO developed the search strategy, reviewed and evaluated the articles. AS wrote the manuscript.

Ethical approval

Not required.

Notes on contributor

Dr. Aysu Selcuk is a lecturer at Ankara University, Faculty of Pharmacy, Department of Clinical Pharmacy. She graduated from School of Pharmacy in 2012. She did her Master’s degree in Clinical Pharmacy in 2014. Afterwards, she accomplished her PhD degree from National University of Singapore in 2019. Her research interests are antimicrobial stewardship, geriatrics, pharmacy education and pharmacy practice in primary health care. She is also working as an advisor and a coordinator in various projects of the International Pharmaceutical Federation and the Turkish Pharmacist' Association.