Hospital antibiotic use according to the WHO Access, Watch and Reserve (AWaRe) Classification - Argentina, 2021

Anti-microbial resistance

The AWaRe Classification is a World Health Organization (WHO) tool to reduce antimicrobial resistance (AMR) and orient decision-making by enabling countries to evaluate their overall quality of antibiotic use. To reduce AMR, WHO recommends that the percentage of Access narrow-spectrum antibiotics should be greater than 60%. The aim is to evaluate the use of antibiotics in adult and pediatric hospitalized patients in Argentina in 2021 following the WHO AWaRe Classification.

Point prevalence survey conducted by the National Program of Epidemiology and Control of Hospital-Acquired Infections in adult and pediatric inpatients of 109 public and 51 private healthcare institutions. Data from medical records was collected using ad hoc software called SisCAM. The proportion of antibiotic use was calculated for each of the 2021 WHO AWaRe categories: Access, Watch, Reserve and Not Recommended. Antibiotics not included in any of these groups were defined as Unclassified. 61 antibiotics were included, with ATC codes J01.

7852 antibiotics were prescribed in 13708 patients, 6373 used in adults and 1479 in pediatrics.

Watch antibiotics (48.85%, 3113/6373) were the most prescribed among adult patients, followed by Access (44.44%, 2832/6373) and Reserve (6.03%, 384/6373) antibiotics. 0.02% (1/6373) of the antibiotics were Unclassified and the use of 0.67% (43/6373) antibiotics was not recommended. In pediatric patients, 53.82% (796/1479) of antibiotics prescribed belonged to Access, 44.62% (660/1479) to Watch, and 1.42% (21/1479) to the Reserve group. 0.07% (1/1479) of antibiotics were Unclassified and 0.07% (1/1479) were not recommended for use.

The proportion of Access antibiotics was lower than that recommended by WHO. High use of Watch broad-spectrum antibiotics in both adult and pediatric hospitalized patients is a key area for improvement, as well as the use of Reserve antibiotics among adult patients. These metrics indicate the need to implement antibiotic stewardship interventions in Argentina.

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