الفهرس 
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Abstract
Antimicrobial resistance (AMR) is one of the most alarming threats to global health, which has resulted in significant human and economic loss worldwide. Rational antimicrobial use is a cornerstone for the containment of antimicrobial resistance as well as good clinical and economic outcomes. However, inappropriate use of antimicrobials has a dire consequence on patients as well as the general population. This study was therefore designed to assess the practice of antimicrobial utilization and clinical outcomes in the management by applying the specified indicators provided by WHO methodology so as to detect the most common problems arising from antimicrobial use at the study site.
Our study was a prospective, descriptive and observational study, designed according to the WHO guidelines and methods and to the objectives of the study. It was conducted in a secondary care hospital in Al Behaira governorate, which is a 278-bed hospital with all specialty, 500 physicians and pharmacists, 600 nurses and 266 paramedical staff who attend an average of 2047 patients per month.
Purposively, ten wards including the department of general medicine, surgery department, intensive care unit (ICU), pediatric intensive care unit, Burn ICU unit, Neurology ICU unit, Obstetric ward and Cardiology ward were selected to collect the required data. In addition, some part of our data was collected from the Pharmacy Department of the hospital.
224 patients, from both genders and all age groups, admitted to the hospital during the study period from January 2019 to the end of July 2019, were included in our study. The standard forms provided by WHO were used for data collection.
The indicators are related to 4 general areas of antimicrobial use namely, hospital indicators, prescribing indicators, patient care indicators and supplemental indicators.
The data collection forms included 7 instruments namely, basic Information, form to record antimicrobial treatments, form to record surgical prophylaxis, form to record medicine purchases, antimicrobials purchased, cumulative purchase of antimicrobials and availability of a set of key indicator antimicrobials and time out of stock.
All the collected data were tabulated and analyzed using descriptive statistics parameters.
Our results found that antibiotics were the most common type of antimicrobials prescribed, where 90.2 % of our studied patients received antimicrobial agents. The minority of antimicrobial agents were prescribed in the general medicine department and the majority in the surgical and the ICU departments.
Chapter (6): Summary, Conclusions & Recommendations
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It was found that each patient was admitted to the hospital for an average of 4.9 days and the duration of prescribed antimicrobial treatment for each subject was found to be 5.4 days.
Among 202 patients who were prescribed antimicrobial drugs, 122(60.4 %) patients received one antimicrobial, 58(28.7%) received two antimicrobials, and 19 (9.4 %) received three antibacterial drugs, 2 patients 3 (1.5 %) received four or more antibacterial agents. It is observed that only 6.45% of patients who are prescribed antimicrobials have undergone a culture sensitivity test.
In our study it was observed that an approved hospital formulary list exists in the hospital, in which 20 antimicrobial agents were included and identified by both generic names as well as brand names. Among these 20 agents, which must be available in the hospital pharmacy store, 16 (80 %) antimicrobials were available while remaining 4 (20 %) antimicrobials were out of stock. The average number of days that a set of key antimicrobials was out of stock was calculated and found to be 18.5 days over the past 6 months or 3.08 days per month.
It was observed that in C.S surgery all patients who have antimicrobial agents for prophylactic use were not prescribed according to STGs.
Also, it was observed that for patients with empirical use, antimicrobial agents were not prescribed according to STGS and not depending on culture and sensitivity tests. However, in patients with infectious diseases like pneumonia, all patients’ antimicrobial agents were prescribed according to STGs and culture guided and shifting to directed therapy especially at NICU department.
The average cost of antimicrobials prescribed per patient was 276 Egyptian pounds.
The hospital purchases of medicines were reviewed and it was found that 13.7 % of total hospital medicine costs during the study period was spent on purchasing antimicrobial agents.
The results of the current study highlight that antimicrobial prescribing, and utilization patterns are less than optimal. This is in terms of, antimicrobial stock out days, percentage of antimicrobial prescribing, average cost per patient, and antimicrobial sensitivity testing; where things could be improved. It was also seen that majority of antimicrobial prescribing were not based on antimicrobial sensitivity test reports and were prescribed empirically.
There are significant implications of the present study for policy and practice. Consequently, physicians must keep a clear understanding of need for microbiological diagnosis, use of antibiotics and make good judgment in clinical situations.
This study has a few limitations like, limited sample size, and study was only conducted in one facility, therefore the results may not be generalized, and we excluded patients from outpatient department.
Hence, there is a need to promote rational use of antimicrobials, as their irrational use would lead to antimicrobial resistance.