The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (GLOBAL-PPS): Results of Antimicrobial Prescribing in Paediatric Units in Georgia

Background: We used a uniform and standardized method for surveillance of antimicrobial use to assess overall quantity and quality of antibiotic prescribing in Georgia (Eastern Europe). bioMérieux provided unrestricted funding support for the survey.

Methods: The Global-PPS was conducted in four, nine and six different Georgian hospitals in 2015, 2017 and 2018 respectively. The survey included all paediatric inpatients receiving an antimicrobial on the day of PPS. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp, Belgium (www.global-pps.com). Because of the different hospitals included, merged results are presented.

Results: In total 20 paediatric wards with 250 inpatients were surveyed of which 61.4% admitted to hospitals in Tbilisi. Overall antimicrobial prevalence was 84.6% with highest rates found in paediatric medical wards (63.1%) and neonatal intensive care units (82.0%). The most frequent indications for antimicrobial use were pneumonia (44.8%, 101 patients). In total 223 antibacterials for systemic use (ATC J01) were prescribed of which ceftriaxone accounted for 35.5%, followed by ampicillin/sulbactam (20.4%) and azithromycin (16.0%). Out of all patients treated for pneumonia, 14.8% got meropenem. Out of all patients on surgical prophylaxis for the gastrointestinal tract, 76.0% received ceftriaxone, 84% used more than 3 day. With respect to antimicrobial quality indicators, the reason in notes was documented in 81.7%; a stop review date in 18.2%. Guidelines were missing in 9.7% and overall compliance to antibiotic guidelines was 90.2%. Empiric therapy was most common (92.8%). In 88.4% of patients CRP was used for treatment decision making.

Conclusions: The high prevalence of overall antibiotic use, particularly ceftriaxone and meropenem, the irrational antimicrobial prophylaxis in surgery and the high rate of empirical therapy are worrisome findings. Application of CRP for decision making indicates an attempt of rational antibiotic use. It is reasonable to set up feasible antimicrobial stewardship interventions to enhance appropriate antibiotic prescribing.