Antimicrobial Resistance and Antibiotic Prescribing Patterns in Hospitalized Patients: A Multicenter Assessment of Clinical and Epidemiological Determinants

Abstract

Background: National antimicrobial resistance (AMR) surveillance and hospital prescribing studies from Pakistan give complementary evidence, but the two aren’t linked.
Objective: To describe organism- and antibiotic-specific resistance and inpatient antimicrobial use in Pakistan, and to show where comparisons across published sources break down.
Methods: We pulled together published aggregate findings from the national AMR surveillance report of Pakistan’s National Institutes of Health (NIH) for 2021–2022 and from selected hospital studies found through targeted literature searches. We kept each study’s population, numerators, denominators, and definitions as originally reported. This isn’t a comprehensive systematic review or a linked patient-level analysis.
Results: The NIH reported 132,269 nonduplicate isolates from 19 laboratories in 2021 and 229,617 from 26 laboratories in 2022. Because participation changed, the increase can’t be read as a trend in incidence. In 2022, the source reported ceftriaxone resistance in 74.6% of 77,998 tested E. coli isolates and 66.4% of 26,087 tested K. pneumoniae isolates. Separately, a point-prevalence survey in 13 Punjab hospitals found antimicrobial exposure in 1,516 of 1,954 inpatients (77.6%; Wilson 95% CI, 75.7–79.4%, which we calculated independently).
Conclusion: Published resistance and hospital antimicrobial-use estimates point to separate priorities for surveillance and stewardship. Because the sources aren’t linked, they can’t establish patient-level links between prescribing and resistance, causal effects, or adjusted clinical determinants.