PP 10 - Point-prevalence survey of antibacterial use in selected public hospitals in Sri Lanka: Findings and implications for practiceplications for practice

Wickramasinghe  SS^1,2, Wijayaratne GB^1,2, Bodinayake  CK^2.3,15, Weerasinghe SA², Thabrew HHPMJ^1,2, Dharmaratne GSK⁴, Priyarangani WKAP⁵, Priyanthi AAD⁶, Devakanthan B⁷, Francis VR⁸, Ranasinghe T⁹, Patabendige G ¹⁰,  Kothalawala M ¹⁰, Abeywardena M¹¹, Abeykoon M¹¹, Ramachandran R¹², Suganthan N¹³, Wickramasuriya U¹⁴, Obale A¹⁵, Ramanayake SV², Ubeysekara H¹⁶,  Kurukulasooriya MRP², Anderson D¹⁷,  Woods CW¹⁵,¹⁷, Tillekeratne LG^2,3,15,17, Nagahawatte ADS^1,2,15  , ¹Department of Microbiology, Faculty of Medicine, University of Ruhuna, Sri Lanka, ²Duke-Ruhuna Collaborative Research Center, Faculty of Medicine, University of Ruhuna, Sri Lanka, ³Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka, ⁴Ministry of Health, Sri Lanka, ⁵District General Hospital, Hambantota, Sri Lanka, ⁶Base Hospital, Tangalle, Sri Lanka, ⁷Teaching Hospital, Batticaloa, Sri Lanka, ⁸Faculty of Healthcare Sciences, Eastern University, Sri Lanka, ⁹Faculty of Medical Sciences, University of Sri Jayawardenapura, Sri Lanka, ¹⁰National Hospital of Sri Lanka, Colombo, Sri Lanka, ¹¹National Hospital Kandy, Kandy, Sri Lanka, ¹²Teaching Hospital Jaffna, Jaffna, Sri Lanka, ¹³Faculty of Medicine, University of Jaffna, Sri Lanka, ¹⁴Teaching Hospital Anuradhapura, Anuradhapura, Sri Lanka, ¹⁵Duke Global health Institute, NC, USA, ¹⁶Provincial Director Office, Sabaragamuwa province, Sri Lanka, ¹⁷Department of Medicine, Duke University School of Medicine, NC, USA

Abstract

Introduction

Antimicrobial resistance (AMR) is a global health crisis that is driven by inappropriate antibacterial use.

Objectives

The study aimed to identify the prevalence, patterns and indications of antibacterial use in selected public hospitals in Sri Lanka.

Design, setting, and methods

Single-day, point-prevalence surveys according to standard WHO protocol were conducted among inpatients in medical, surgical, and pediatric wards and intensive-care units (ICU) in 18 public hospitals in six provinces in Sri Lanka in Aug-Nov 2024. One each from tertiary, secondary and primary-level hospitals were included per province. Type of antibacterial prescribed, indications, and bacterial culture results at time of survey were collected from medical records.

Results

Of 3,866 patients, 2327 were from tertiary, 1396 from secondary, and 141 from primary hospitals. Prevalence of antibacterial use in tertiary, secondary and primary hospitals was 56.7%, 52.7%, and 49.7%, respectively. The highest antibacterial use was in ICUs (92.9%), and lowest was in mixed medical-surgical wards (45.7%). Among tertiary and secondary hospitals, commonly prescribed antibacterials were amoxicillin-clavulanate (AMC) (20.4% of total number of antibacterials), 3^rd generation cephalosporins (3GC) (19.5%), and metronidazole (10.8%). AMC (32.1%), 2^nd generation cephalosporins (24.6%), and 1^st generation cephalosporins (11.1%) were common in primary hospitals. Carbapenems use was 6.9% and 4.3% in tertiary and secondary hospitals respectively. AMC (30.3%) and 3GC (27.6%) were the most common in mixed medical-surgical (30.3%) and medical wards (27.6%) respectively while carbapenems were most common in ICUs (18.8%). Use of ‘Access’, ‘Watch’ and ‘Reserve’ group antibacterials was 58.3%, 40.4%, 1% in tertiary, 65.5%, 33.9%, 0.4% in secondary, and 91.3%, 8.6%, 0% in primary hospitals respectively.

Common indications for antibacterials across all healthcare levels were cellulitis/soft tissue infections (28.9%), lower respiratory tract infections (25.2%), and urinary tract infections (14.8%). Of all, 44.5% of patients on surgical prophylaxis and 20.6% on upper respiratory infections were prescribed inappropriate antibiotics. Associated microbiologic cultures were ordered in 37.5% of patients in tertiary, 18% in secondary hospitals.

Conclusions

This study describes the current landscape of antibacterial use in public hospitals in Sri Lanka. Adherence to antibiotic prescribing guidelines and the reduction of broad-spectrum antibacterial use were identified as two main antimicrobial stewardship targets.

Acknowledgements

Financial assistance by pilot grant fund from the Duke Global Health Institute is acknowledged.

This work has been previously presented at the American Society of Tropical Medicine and Hygiene (ASTMH) conference-2025 in Toronto, Canada.