Antimicrobial prescribing in referral hospitals in Timor-Leste: results of the first two national point prevalence surveys, 2020-21

Guilherme Ximenes; Sajal K Saha; Helio Guterres; Adriano Vieira; Lisa Harris; Michelle Mahony; Agata Dos Santos; Lucia Toto; Elfiana Amaral; Jessie C Spargo; Sze Yen Tay; Salvador Amaral; Karen Champlin; Anthony D K Draper; Joshua R Francis; Jennifer Yan; Sarah A Lynar

doi:10.1093/jacamr/dlae123

Antimicrobial prescribing in referral hospitals in Timor-Leste: results of the first two national point prevalence surveys, 2020-21

JAC Antimicrob Resist. 2024 Aug 1;6(4):dlae123. doi: 10.1093/jacamr/dlae123. eCollection 2024 Aug.

Authors

Guilherme Ximenes^{1

2}, Sajal K Saha^{1

3

4}, Helio Guterres⁵, Adriano Vieira¹, Lisa Harris¹, Michelle Mahony^{1

6}, Agata Dos Santos², Lucia Toto^{1

5}, Elfiana Amaral^{1

5}, Jessie C Spargo⁶, Sze Yen Tay^{1

7}, Salvador Amaral¹, Karen Champlin¹, Anthony D K Draper^{1

8

9}, Joshua R Francis^{1

6}, Jennifer Yan^{1

6}, Sarah A Lynar^{1

7

8}

Affiliations

¹ Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste.
² Pharmacy Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste.
³ Department of Infectious Diseases, Melbourne Medical School, National Centre for Antimicrobial Stewardship (NCAS), University of Melbourne, Melbourne, 3010 Victoria, Australia.
⁴ Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), IMPACT, Deakin University, Geelong 3220, VIC, Australia.
⁵ Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste.
⁶ Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia.
⁷ Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia.
⁸ Northern Territory Centre for Disease Control, Darwin 0810, Northern Territory, Australia.
⁹ National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra 0200, Australian Capital Territory, Australia.

Abstract

Objectives: To describe antimicrobial use (AMU) in patients admitted to hospitals in Timor-Leste.

Methods: In 2020 and 2021, we undertook antimicrobial prescribing point prevalence surveys across all six hospitals in Timor-Leste (one national and five municipal) to describe AMU and appropriateness in admitted patients.

Results: In 2020, 291/394 (73.9%) surveyed patients had been prescribed antimicrobials, compared with 260/403 (64.5%) in 2021 (P = 0.004). Most (309/551; 56.1%) were prescribed one antimicrobial, and 179/551 (32.5%) were prescribed two. The most commonly prescribed antibiotics were ceftriaxone (38.5% in 2020, 41.5% in 2021) and ampicillin (35.7% in 2020, 32.3% in 2021), followed by gentamicin, metronidazole and cloxacillin. Reserve antibiotics like meropenem and vancomycin were minimally used. Of all antimicrobial prescriptions, 70.8% were deemed appropriate in 2020 and 69.1% in 2021. Antimicrobial prescriptions for surgical and post-partum prophylaxis were frequently deemed inappropriate [37/50 (74.0%) and 39/44 (88.6%) prescriptions, respectively].

Conclusions: Most patients admitted to hospital in Timor-Leste are prescribed antimicrobials, and approximately one-third of these prescriptions are inappropriate. However, this was in the context of limited local guideline availability at the time of surveys and limited microbiological culture capacity outside of the capital, Dili. Improved microbiological guidance, iterative guideline revisions based on local antimicrobial resistance (AMR) surveillance data, and enhanced stewardship activities including further point prevalence studies, could improve antimicrobial use, optimize patient outcomes and reduce AMR in Timor-Leste.