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. 2022 Jul 9:27:100531.
doi: 10.1016/j.lanwpc.2022.100531. eCollection 2022 Oct.

Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use

Vilada Chansamouth  1   2   3 , Danoy Chommanam  1 , Tamalee Roberts  1   3 , Sommay Keomany  4 , Viladeth Paphasiri  5 , Chanthala Phamisith  6 , Siho Sengsavang  7 , Khamsay Detleuxay  8 , Phisith Phoutsavath  8 , Sengvong Bouthavong  9 , Anousone Douangnouvong  1 , Manivanh Vongsouvath  1   2 , Sommana Rattana  10 , Bounxou Keohavong  11 , Nicholas P J Day  12 , Paul Turner  3   13 , H Rogier van Doorn  3   14 , Mayfong Mayxay  1   3   15 , Elizabeth A Ashley  1   3   12 , Paul N Newton  1   3   12   16
Affiliations

Evaluation of trends in hospital antimicrobial use in the Lao PDR using repeated point-prevalence surveys-evidence to improve treatment guideline use

Vilada Chansamouth et al. Lancet Reg Health West Pac. .

Abstract

Background: Antimicrobial use (AMU) is a key driver of antimicrobial resistance (AMR). There are few data on AMU, to inform optimizing antibiotic stewardship, in the Lao PDR (Laos).

Methods: Point prevalence surveys (PPS) of AMU were conducted at four-month intervals in six general hospitals across Laos from 2017 to 2020, using modified Global-PPS data collection tools. The surveys focused on AMU amongst hospitalized inpatients.

Findings: The overall prevalence of inpatient AMU was 71% (4,377/6,188), varying by hospital and survey round from 50·4% (135/268) to 88·4% (61/69). Of 4,377 patients, 44% received >one antimicrobial. The total number of prescriptions assessed was 6,555. Ceftriaxone was the most commonly used (39·6%) antimicrobial, followed by metronidazole (17%) and gentamicin (10%). Pneumonia was the most common diagnosis among those prescribed antimicrobials in both children aged ≤5 years (29% among aged ≤1 year and 27% among aged >1 to ≤5years) and adults aged ≥15 years at 9%. The percentage of antimicrobial use compliant with local treatment guidelines was 26%; inappropriate use was mainly found for surgical prophylaxis (99%). Adult patients received ACCESS group antimicrobials less commonly than children (47% vs 63%, p-value<0·0001). Most WATCH group prescriptions (99%) were without a microbiological indication.

Interpretation: AMU among hospitalized patients in Laos is high with frequent inappropriate use of antimicrobials, especially as surgical prophylaxis. Continued monitoring and enhanced antimicrobial stewardship interventions are needed in Lao hospitals.

Funding: The Wellcome Trust [Grant numbers 220211/Z/20/Z and 214207/Z/18/Z] and bioMérieux.

Keywords: Antimicrobial resistance; Antimicrobial use; Hospital; Laos; Point prevalence survey; Prescription.

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Conflict of interest statement

H Rogier van Doorn is board member of SEDRIC (Surveillance and Epidemiology of Drug Resistant Infections Consortium). All other authors declare no completing interests. The study received a grant from bioMérieux Singapore to start the project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Figures

Figure 1
Figure 1
Antimicrobial use in six survey hospitals in Laos, from 2017 to 2020, for the five most commonly used antimicrobials.
Figure 2
Figure 2
Trends of antimicrobial use in six survey hospitals in Laos from 2017 to 2020.
Figure 3
Figure 3
Overall use of antibiotics of different AWaRE classifications in six survey hospitals in Laos, from 2017 to 2020.
See this image and copyright information in PMC

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