Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries
Ines Pauwels, Ann Versporten, Nico Drapier, Erika Vlieghe, Herman Goossens, the Global-PPS network, Andi Koraqi, Iris Hoxha, Silva Tafaj, Wanda Cornistein, Rodolfo Quirós, Martín Hojman, Lilit Ghazaryan, Kylie Horne, Kelly A. Cairns, Fiona Doukas, Thomas Gottlieb, Erica Sermijn, Katia Verhamme, Christiane Brands, Bruno Van Herendael, Lorenzo Filippin, Wouter Vandewal, Déborah Konopnicki, Evelyne Maillart, Liliana Teixeira Lopes, Pauline Papin, Ilse Smits, Hilde Jansens, Sofie Bartholomeus, Anne‐Marie Van den Abeele, Sophia Steyaert, Anne Piette, Franky Buyle, Reinoud Cartuyvels, Stijn Jonckheere, Ingrid Wybo, Lorenz Vanneste, Delphine Mathieu, Éric Firre, Veerle Westelinck, Philippe Gadisseux, Thierry Dugernier, Kristof Bafort, Viviane Gonissen, Vanessa Vanderper, Patrick Gabriels, Frank Weekers, Philippe Michel, Ann Van Liedekerke, Michiel Costers, Boudewijn Catry, Amela Dedeić-Ljubović, Ana Cristina Gales, Ana Paula Matos Porto, Sílvia Figueiredo Costa, Emma Keuleyan, Apollinaire Beidi, Youssouph Cissohko, Habsatou Blakwe, Ngassa Batchaya Basile, Greg J. German, Sarah Lutes, Jennifer Boswell, Dominik Mertz, Tuyen Nguyen, Timothy MacLaggan, Daniel L. Landry, Anita Ang, Daniel J. G. Thirion, Charles Frenette, Yannick Émond, Jacqueline Roberts, Sandra Chang, Justin Kosar, Louis Valiquette, Ginette Dutrisac, Kevin Afra, Allison McGeer, Marie Carrier, Jennifer Grant, Jaime Labarca, Camila Carvajal, HongYi Lin, Qiang Wang, Jing Yang, Wenjie Yang, Jorge Alberto Cortés, Juan Villalobos-Vindas, Carlos Ramírez-Valverde, Jasminka Horvatić, Irina Pristaš, Niki I. Paphitou, Maija‐Liisa Rummukainen, Antoine Froissart, Philippe Vanhems, Karaman Pagava, Irma Korinteli, Tobias Brandt, Johannes Gaertner
Abstract
OBJECTIVES: The WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population. METHODS: The Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed. RESULTS: Regional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). Reserve use ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America. There were large differences in AWaRe prescribing at country level. Watch antibiotics were prescribed for a range of very different indications worldwide, both for therapeutic and prophylactic use. CONCLUSIONS: We observed considerable variations in AWaRe prescribing and high use of Watch antibiotics, particularly in lower- and upper-middle-income countries, followed by high-income countries. The WHO AWaRe classification has an instrumental role to play in local and national stewardship activities to assess prescribing patterns and to inform and evaluate stewardship activities.