Evaluation of the antimicrobial prescribing pattern and the stewardship programs among COVID-19 hospitals in the capital city of Kurdistan-Northern Iraq: A multicenter point prevalence study

Abstract
Antimicrobial resistance (AMR) is a significant threat to healthcare system as making infections difficult to be cured and enhances disease transmission and death. Thus, prudent antimicrobial use is crucial to combat AMR, particularly in Erbil City/Northern Iraq because of the high rate of multidrug-resistance microorganisms. There is limited data on the extent and quality of antimicrobial use in Kurdistan, including COVID-19 hospitals. This study aimed to assess the prevalence and quality indicators of antimicrobial use, the status of antimicrobial stewardship program (ASP), and hospital capacity infrastructures. From September 30th 2021 to February 8th 2022, all COVID-19 hospitals in Erbil/Northern Iraq were surveyed using the Global point prevalence survey methodology. Prevalence of antimicrobial use was at the top (100%, n = 71/71), and carbapenem was the most used antimicrobial class (44.0%, n = 55/125). The majority of the prescribed antimicrobials were in WHO Watch class (88.4%, n = 76/86), high use of parenteral therapy (99.2%, n = 124/125), low targeted therapy (2.4%, n = 3/125) and neither stop/review dates documented, nor local guidelines were available. ASP was not implemented while most of the hospitals had a priority for the medium or long term to implement ASP (66.7%, n = 2/3) out of 11 hospital capacity infrastructures, only four of them were present adequately. The findings demonstrated a high and sub-optimal quality of antimicrobial prescriptions, lack of ASP, and inadequate hospital capacity infrastructures. Quick action is necessary to establish ASP to combat antimicrobial resistance, and the critical target areas include development of the local guidelines and documenting stop/review date.