Öz
Giriş: Antimikrobiyal yönetim sürecinin en önemli adımlarından biri, antimikrobiyal kullanımın ölçülmesidir. Bu çalışma, Irak’ta etkili bir antimikrobiyal gözetim programı oluşturmak için Irak hastanelerindeki antimikrobiyal reçete modellerini bir anket yaparak değerlendirmeyi ve kalite göstergelerini belirlemeyi amaçlamaktadır.
Gereç ve Yöntem: Irak’ın Bağdat şehrindeki beş ana eğitim hastanesinde nokta prevalans çalışması (PPS) gerçekleştirildi. Bu anket çalışması, anketin yapıldığı gün hastanelere kabul edilen tüm hastaları içermektedir. Çalışma, anketin yapıldığı gün antimikrobiyal tedavi alan hastalar hakkında kapsamlı verileri takip etti.
Bulgular: Yatarak tedavi gören 808 hastanın %66,7’si en az bir antimikrobiyal ajan ile tedavi edildi. Yenidoğan yoğun bakım ünitesi en yüksek antimikrobiyal ilaç reçete oranına (%97,2) sahipken, yetişkin yoğun bakım üniteleri en düşük orana (%41,7) sahipti. Reçete edilen antibiyotiklerin yarısı cerrahi ve tıbbi profilaktik endikasyonlar için kullanıldı. Üçüncü kuşak sefalosporin, özellikle seftriakson, tüm endikasyon türleri için en yaygın kullanılan antibiyotikti (%31,5). Sepsisli hastalarda en çok reçete edilen antibiyotikler vankomisin ve meropenemdi (her biri %32). Reçete edilen antibiyotiklerin yaklaşık %98,8’i ampirik olarak kullanıldı. Belirtilen bulaşıcı hastalıkların tedavisinde hiçbir kurumsal rehber uygulanmadı. Kullanılan antibiyotiklerin çoğu parenteral olarak uygulandı. Kültür duyarlılığı testleri sadece 10 (%1,2) hastada yapıldı.
Sonuç: Bu çalışma, Irak hastanelerinde profilaktik antibiyotiklerin aşırı reçetelenmesi ve son derece yüksek ampirik antibiyotik kullanımı gibi iyileştirilmesi gereken birkaç kalite göstergesini ortaya çıkarmıştır. Global-PPS, Irak’ın sağlık otoritelerinin, antimikrobiyal ajanların daha uygun olarak reçetelendirilmesi için bir eylem planı tasarlamasına yardımcı olacak veriler sağlamaktadır.
Anahtar Kelimeler: Antimikrobiyal yönetim, enfeksiyon hastalıkları, Irak, antibiyotik reçetesi
Kaynakça
O’Neill J. The Review on Antimicrobial Resistance. Tackling drug-resistant infections globally: final report and recommendations Government of the United Kingdom. 2016.
Michael CA, Dominey-Howes D, Labbate M. The antimicrobial resistance crisis: causes, consequences, and management. Front Public Health. 2014;2:145.
World Health Organization (WHO). Global Action Plan on Antimicrobial Resistance. Geneva: World Health Organization; 2015.
Sommer MOA, Munck C, Toft-Kehler RV, Andersson DI. Prediction of antibiotic resistance: time for a new preclinical paradigm? Nat Rev Microbiol. 2017;15:689-96.
World Health Organization (WHO). WHO Methodology for Point Prevalence Survey on Antibiotic Use in Hospitals. 2019. p.102.
WHO_EMRO. Iraq develops national action plan to address antimicrobial resistance. 19 September 2017. Available from: http://www.emro.who.int/index.html
Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H; ARPEC project group. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016;71:1106-17.
Hussein NH. Emergence of NDM-1 among carbapenem-resistant Klebsiella pneumoniae in Iraqi hospitals. Acta Microbiol Immunol Hung. 2018;65:211-27.
Harb A, O’Dea M, Hanan ZK, Abraham S, Habib I. Prevalence, risk factors and antimicrobial resistance of Salmonella diarrhoeal infection among children in Thi-Qar Governorate, Iraq. Epidemiol Infect. 2017;145:3486-96.
Al-Jumaili AA, Hussein AH, Al-Rekabi MD, Raheem SA, Ernst EJ. Antimicrobial utilization in an Iraqi province: a comprehensive evaluation of antibiotic source and cost. Int J Pharm Pract. 2017;25:81-8.
Abd Al-Razaq A, Alwan D, Abd Al-Hameed B, Younis W, Abd Al-Raheem Y, Jalal M, Al-Zwaini I. G304(P) Prescribing pattern of antibiotics in al-elwia pediatric teaching hospital, Baghdad, 201. Archives of Disease in Childhood. 2019;104:A124.
Nassr OA, Alridha AMA, Naser RA, Abbas RS. Antibiotic Prescribing in the Acute Care in Iraq. World Academy of Sciense, Engineering and Technology International Journal of Pharmacological and Pharmaceutical Sciences. 2018;12:485-9.
Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, Jarlier V, Nathwani D, Goossens H; Global-PPS network. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2016;6:619-29.
World Health Organization (WHO). ATC/DDD Index. 2019. Available from: https://www.whocc.no/atc_ddd_index/
Plachouras D, Kärki T, Hansen S, Hopkins S, Lyytikäinen O, Moro ML, Reilly J, Zarb P, Zingg W, Kinross P, Weist K, Monnet DL, Suetens C; The Point Prevalence Survey Study Group. Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill. 2018;23:1800393.
Versporten A, Drapier N, Zarb P, Caniaux I, Gros M-F, Miller M, Jarlier V, Nathwani D, Goossesns H. The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS): A Worldwide Antimicrobial Web-Based Point Prevalence Survey. Open Forum Infectious Diseases. 2015;2(Suppl_1):71.
Oduyebo O, Olayinka A, Iregbu K, Versporten A, Goossens H, Nwajiobi-Princewill P, Jimoh O, Ige TO, Aigbe A,Ola-Bello O, Aboderin AO, Ogunsola FT. A point prevalence survey of antimicrobial prescribing in four Nigerian Tertiary Hospitals. Annals of Tropical Pathology. 2017;8:42-6.
Saleem Z, Hassali MA, Versporten A, Godman B, Hashmi FK, Goossens H, Saleem F. A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications. Expert Rev Anti Infect Ther. 2019;17:285-93.
Elhajji FD, Al-Taani GM, Anani L, Al-Masri S, Abdalaziz H, Qabba’h SH, Al Bawab AQ, Scott M, Farren D, Gilmore F, Versporten A, Goossens H, Aldeyab MA. Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan. BMC Health Serv Res. 2018;18:849.
Al Matar M, Enani M, Binsaleh G, Roushdy H, Alokaili D, Al Bannai A, Khidir Y, Al-Abdely H. Point prevalence survey of antibiotic use in 26 Saudi hospitals in 2016. J Infect Public Health. 2019;12:77-82.
Fahimzad A, Eydian Z, Karimi A, Shiva F, Sayyahfar S, Kahbazi M, Rahbarimanesh A, Sedighi I, Arjmand R, Soleimani G, Sanaei Dashti A, Abdinia B, Mostafavi N, Nikfar R, Abedini M, Rezaei MS, Mohammadpour A, Hashemian H, Hidari H, Ghadiri K, Entezari Heravi R. Surveillance of Antibiotic Consumption Point Prevalence Survey 2014: Antimicrobial Prescribing in Pediatrics Wards of 16 Iranian Hospitals. Arch Iran Med. 2016;19:204-9.
Braga IA, Campos PA, Batistão DWDF, Gontijo Filho PP, Ribas RM. Using point prevalence survey to define burden of antimicrobial use among 35 adult intensive care units in Brazil. Infect Dis (Lond). 2019;51:459-62.
Anand Paramadhas BD, Tiroyakgosi C, Mpinda-Joseph P, Morokotso M, Matome M, Sinkala F, Gaolebe M, Malone B, Molosiwa E, Shanmugam MG, Raseatlholo GP, Masilo J, Oyeniran Y, Marumoloa S, Maakelo OG, Katjakae I, Kgatlwane J, Godman B, Massele A. Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications. Expert Rev Anti Infect Ther. 2019;17:535-46.
Ventola CL. The antibiotic resistance crisis: part 1: causes and threats. P T. 2015;40:277-83.
Xie DS, Xiang LL, Li R, Hu Q, Luo QQ, Xiong W. A multicenter point-prevalence survey of antibiotic use in 13 Chinese hospitals. J Infect Public Health. 2015;8:55-61.
Talaat M, Saied T, Kandeel A, El-Ata GA, El-Kholy A, Hafez S, Osman A, Razik MA, Ismail G, El-Masry S, Galal R, Yehia M, Amer A, Calfee DP. A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt. Antibiotics (Basel). 2014;3:450-60.
Labi AK, Obeng-Nkrumah N, Nartey ET, Bjerrum S, Adu-Aryee NA, Ofori-Adjei YA, Yawson AE, Newman MJ. Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey. Antimicrob Resist Infect Control. 2018;7:15.
Gharbi M, Doerholt K, Vergnano S, Bielicki JA, Paulus S, Menson E, Riordan A, Lyall H, Patel SV, Bernatoniene J, Versporten A, Heginbothom M, Goossens H, Sharland M; ARPEC project Group members. Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK. BMJ Open. 2016;6:012675.
Magill SS, Edwards JR, Beldavs ZG, Dumyati G, Janelle SJ, Kainer MA, Lynfield R, Nadle J, Neuhauser MM, Ray SM, Richards K, Rodriguez R, Thompson DL, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014;312:1438-46.
Al Hilfi TK, Lafta R, Burnham G. Health services in Iraq. Lancet. 2013;381:939-48.
Soltani J, Pouladfar G, Versporten A, Sharland M, Goossens H, Jafarpour Z, Soleimani N. Point Prevalence Survey of Antimicrobial Prescription and Infection in Pediatric and Neonatal Wards of Two Iranian Teaching Hospitals. Erciyes Med J. 2019;41:25-32.
Singh SK, Sengupta S, Antony R, Bhattacharya S, Mukhopadhyay C, Ramasubramanian V, Sharma A, Sahu S, Nirkhiwale S, Gupta S, Rohit A, Sharma S, Raghavan V, Barman P, Sood S, Mamtora D, Rengaswamy S, Arora A, Goossens H, Versporten A. Variations in antibiotic use across India: multi-centre study through Global Point Prevalence survey. J Hosp Infect. 2019;103:280-3.
Garau J, Nicolau DP, Wullt B, Bassetti M. Antibiotic stewardship challenges in the management of community-acquired infections for prevention of escalating antibiotic resistance. J Glob Antimicrob Resist. 2014;2:245-53.
Ohl CA, Luther VP. Antimicrobial stewardship for inpatient facilities. J Hosp Med. 2011;6:4-15.
