Assessment of antibiotic use among hospitalized patients using who point prevalence survey (pps) tool. case study: Ruhengeri level two teaching hospital

Abstract

Background: The inappropriate use of antibiotics in hospitals is a major contributor to antimicrobial resistance (AMR), posing significant public health challenges. In Rwanda, limited data exists on antibiotic prescribing patterns, making it difficult to implement targeted antimicrobial stewardship programs. This study assesses antibiotic use among hospitalized patients at Ruhengeri Level Two Teaching Hospital using the World Health Organization (WHO) Point Prevalence Survey (PPS) tool. Methods: A cross-sectional observational study was conducted from January 17 to January 28, 2025. Data were collected on patient demographics, antibiotic prescriptions, and treatment indications using the WHO PPS methodology. Descriptive statistics were used to analyze the prevalence, prescribing patterns, and compliance with hospital and national guidelines. Chisquare tests and trend analyses were applied to assess associations between categorical variables. Results: Among 270 hospitalized patients, 117 (43%) were on antibiotic therapy. The highest prevalence was observed in the pediatric (62%) and Neonatology (57%) departments. The most prescribed antibiotics were Ampicillin (20.3%) and Ceftriaxone (17.8%). Alarmingly, 100% of prescriptions were empirical, with no culture-based therapy recorded. Additionally, only 6.8% of patients were switched from intravenous to oral antibiotics, despite WHO recommendations for de-escalation. Approximately 40.3% of antibiotics belonged to the WHO Watch category, indicating a need for improved prescribing practices. Conclusion: The findings highlight excessive empirical antibiotic prescribing, a lack of microbiological diagnostics, and limited de-escalation practices, increasing the risk of AMR. Strengthening antimicrobial stewardship programs, improving laboratory capacity for culture testing, and promoting guideline-based antibiotic prescribing are essential to optimizing antibiotic use at Ruhengeri Level Two Teaching Hospital.