Antimicrobial utilization among hospitalized patients according to WHO AWaRe classification: Results from a multicentre point prevalence survey in Saudi Arabia

Background: Antimicrobial resistance (AMR) threatens global health by reducing the efficacy of common infection treatments. This study examines antimicrobial use in Saudi Arabian hospitals, identifies influencing factors, and proposes interventions using the World Health Organization's (WHO) Access, Watch, Reserve (AWaRe) classification system. Methods: A cross-sectional, multicentre point prevalence survey (PPS) of antimicrobial utilization was conducted in 10 hospitals across 6 regions of Saudi Arabia September 2023. All inpatients receiving antimicrobials on the PPS day were included. Data collection utilized the Global PPS tool developed by the University of Antwerp, Belgium. Results: Among 2890 inpatients, 766 (26.5%) were prescribed at least one antimicrobial, resulting in a total of 982 prescriptions. The primary indications for these antimicrobials were community-acquired infections (37.1%), Healthcare-associated infections (35.9%), surgical prophylaxis (15.4%), unknown reasons (8.7%), medical prophylaxis (2.5%), and other reasons (0.3%). The most common reasons for antimicrobial use included pneumonia or lower respiratory tract infections (16.1%), skin and soft tissue infections (11%) and bacteraemia (8.9%). The most frequently prescribed antimicrobial classes were penicillins with beta-lactamase inhibitors (18.5%), carbapenems (15.7%), and third-generation cephalosporins (11.1%). Most of the antimicrobials (66.3%) were classified as Watch antimicrobials, followed by 23.8% as Access, and 8.9% as Reserve. Conclusions: The study provides valuable insights into antimicrobial utilization in Saudi Arabia, offering a baseline for assessing prescribing patterns. While findings may reflect certain antimicrobial stewardship efforts, further investigation is needed to evaluate their impact. The study also highlights key areas for improvement, emphasizing the importance of conducting future PPS to guide antimicrobial stewardship strategies and monitor progress in managing AMR.