ArticlePloS one2026
Antibiotic stewardship benchmarking-Using the WHO point prevalence survey of antimicrobial prescribing in a Tertiary Care Public Hospital, Karachi.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Pharmacoeconomic evaluation of an antimicrobial stewardship program in a tertiary care hospital of Sindh, Pakistan.Pakistan journal of medical sciences · 2026Article
- Drug-related problems and their predictors in pediatric community-acquired infections: the role of pharmacist-led interventions in Pakistan.Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques · 2026Article
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Abstract
backgroundAntimicrobial resistance (AMR) is a global threat, mainly linked to inappropriate use and prescription of antibiotics, Antimicrobial stewardship (AMS) programs have proved to promote responsible antibiotic use and decrease the burden of AMR. The aim of this study is to benchmark antibiotic prescribing patterns and evaluate stewardship practices using the World Health Organization (WHO) Point Prevalence Survey (PPS) methodology in a tertiary care public sector hospital in Karachi.
methodA cross-sectional, prospective PPS was conducted over four weeks in July 2024 at Dow University Hospital, Karachi. The data were extracted from the medical records of the patients using a validated WHO PPS tool by a trained infectious disease physician and pharmacist. All inpatients admitted before or at 8:00 a.m. on survey day, without a planned discharge were included, excluding those from emergency, acute care, day-care surgery, dialysis, and oncology units. Descriptive analysis of the data was performed using Stata version 14.
resultsOut of 224 hospitalized patients at the day of survey, 186 inpatients (adults and children across medical, surgical and critical care wards) were included in the study meeting the inclusion criteria. The study included 50.5% male and 49.5% females, having mean age of 45 (±18) years. The point prevalence of antibiotic use was 83.3% (95% CI: 77.5-88.2%). Community-acquired infections 55.5% (95% CI: 48.7-62.1%) were the most common indication of use. Most antibiotics 99.2%, (95% CI: 95.6-99.9%) were prescribed empirically, with predominant parenteral administration 89.2% (95% CI: 84.5-92.9%) and limited Intravenous-to-oral switch 2.9% (95% CI: 1.3-6.2%). Ceftriaxone (18.5%), piperacillin-tazobactam (18.1%), and meropenem (16.2%) were most frequently used antibiotics. According to WHO Access, Watch and Reserve (AWaRe) classification, 80.8% (95% CI: 75.2-85.6%) of antibiotics belonged to the 'Watch' category, 17.3% (95% CI: 12.6-23.2%) to 'Access', and 1.8% (95% CI: 0.7-4.6%) to 'Reserve'. Cultures showed no growth in 64.8% (95% CI: 55.2-73.6%) of cases. Stewardship interventions were found applicable in 55.4% (95% CI: 48.7-62.0%) of prescriptions due to overuse, dosing errors, and absence of antimicrobial guideline in the hospitals.
conclusionThis study demonstrates that antibiotic utilization exceeded global averages, highlighting the urgent need to develop institutional antimicrobial guidelines, enhance stewardship programs, and improve diagnostic stewardship to curb AMR.
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