Antibiotic use and factors associated with inappropriate prescribing among hospitalized patients: a cross-sectional study in Peru

Abstract

Introduction: Antibiotic use is common in clinical practice, and inappropriate prescribing may increase the risk of the development of multidrug-resistant pathogens. Objective: To determine the point prevalence of antibiotic use and assess the association between culture ordering and appropriate antibiotic prescribing. Methods: A cross-sectional study was conducted among adult inpatients at Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru, in October 2023, using World Health Organization (WHO) methodology. To assess factors associated with inappropriate antibiotic prescribing, Poisson regression models with robust variance were fitted to estimate adjusted prevalence ratios (aPRs) and their corresponding 95% confidence intervals (CIs). Results: Among the 644 patients included, 249 (38.7%) were receiving antibiotics, and 57.8% of prescriptions were inappropriate. Meropenem was the most frequently prescribed antibiotic, and antibiotics in the AWaRe Watch group predominated, accounting for 73.5% of prescriptions. Culture ordering before antibiotic initiation was associated with a lower prevalence of inappropriate prescribing (aPR = 0.77; 95% CI: 0.60–0.99), whereas community-acquired infections were associated with a higher prevalence of inappropriate prescribing (aPR = 1.38; 95% CI: 1.06–1.79). Conclusions: Nearly four in ten inpatients were receiving antibiotics, and more than half of prescriptions were inappropriate, with antibiotics in the AWaRe Watch group predominating. Culture ordering before antibiotic initiation was associated with a lower prevalence of inappropriate antibiotic prescribing.