A Point Prevalence Survey of Intravenous Antimicrobial Use, Antimicrobial Resistant Infections, Clinical Outcomes and Medical Costs Among Inpatients at Mae Sot Hospital

Abstract

Background: Irrational antimicrobial use is a major driver of antimicrobial resistance. Evidence-based surveillance using standardized tools is essential for advancing hospital antimicrobial stewardship programs.

Objectives: To investigate the prevalence of intravenous antimicrobial use, the incidence of antimicrobial-resistant infections, clinical outcomes, and medical costs among inpatients at Mae Sot Hospital.

Methods: A cross-sectional descriptive study utilizing the WHO point prevalence survey (PPS) methodology was conducted between October 20 and 22, 2025, across 28 inpatient wards. Data were analyzed using descriptive statistics.

Results: Of 315 inpatients, 135 received intravenous antimicrobials, yielding a prevalence of 42.9%. The surgical intensive care unit exhibited the highest prevalence (75.0%). Ceftriaxone was the most frequently prescribed antimicrobial (23.4%). Based on the WHO AWaRe classification, the "Watch" group accounted for 62.5% of prescriptions. Notably, ceftriaxone comprised 35.0% of all surgical prophylaxis prescriptions. Thirteen cases of multidrug-resistant infections were found among 48 patients with detected pathogenic microorganisms (27.1%). Patients with hospital-acquired infections had an average length of stay of 34 days, a 28.6% mortality rate, and an average medical cost of THB 260,428 per case.

Conclusion: The hospital demonstrated a high prevalence of "Watch" group antimicrobial use, while hospital-acquired infections were associated with poorer clinical outcomes and increased healthcare costs. These findings support strengthening the hospital's antimicrobial stewardship program through systematic antimicrobial restriction policies and regular audits of surgical antimicrobial prophylaxis.