A Point Prevalence Survey on Antibiotic Use in Surgical Practice from Sri Lanka-Making a Case for Antibiotic Stewardship Initiatives

Antibioticmisuse is a major driver of antibiotic resistance in developing countries. We aimed to determine the prevalence and patterns of antibiotic use in surgical practice at a tertiary care facility in Sri Lanka with special emphasis on post-acute admission dates. This point prevalence survey was conducted among all surgical inpatients at a tertiary care facility in Sri Lanka from March to April 2022. Data were collected using a questionnaire adapted from the World Health Organization (WHO) methodology for point prevalence survey on antibiotic use in hospitals and global point prevalence survey. Data were analyzed using SPSS version 25 with descriptive statistics. Among the 368 participants recruited, 196 were on antibiotics (53.3%, 95% confidence interval: 48.2-58.3%). However, only 18/196 (9.2%) patients knew they were being treated with antibiotics. There were 300 prescriptions issued. The commonest antibiotics prescribed were amoxicillin/clavulanic acid (N = 115), metronidazole (N = 52), and clindamycin (N = 49). Combinations of antibiotics were prescribed for 95 (25.8%) of patients. Double beta-lactams were given to 9 patients (4.6%) and potentially overlapping double anaerobic cover was found in 37 patients (18.9%). As there was a non-uniformity in documenting the indication for antibiotic treatment in the clinical records, we did not analyze the appropriateness of antibiotic therapy. We identified that more than half of the patients were prescribed antibiotics with insufficient documentation on the actual indications. We make a case to improve documentation of the indication for antibiotics. Further, our study emphasizes the need for implementing antimicrobial stewardship initiatives in resource limited settings.