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Dramowski A, Prusakov P, Goff DA, Brink A, Govender NP, Annor AS, Balfour L, Bekker A, Cassim A, Gijzelaar M, Holgate SL, Kolman S, Messina A, Tootla H, Schellack N, van Jaarsveld A, Reddy K, Pillay S, Conradie L, van Niekerk AM, Bester T, Alexander P, Andrews A, Dippenaar M, Bamford C, Brits S, Chirwa P, Erasmus H, Ekermans P, Gounden P, Kriel T, Mawela D, Moncho M, Mphuthi T, Nhari R, Charani E, Sánchez PJ, Bergh DVD. Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa: The Neonatal Antimicrobial Stewardship (NeoAMS) study. Int J Infect Dis 2024; 146:107158. [PMID: 38945432 DOI: 10.1016/j.ijid.2024.107158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/07/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization. METHODS Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis. FINDINGS During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians' acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032). INTERPRETATION This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis. FUNDING A grant from Merck provided partial support.
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Affiliation(s)
- Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | | | - Debra A Goff
- The Ohio State University College of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Adrian Brink
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nelesh P Govender
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ama Sakoa Annor
- Department of Pharmacy, Dr George Mukhari Academic Hospital, Pretoria, South Africa; Department of Clinical pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Liezl Balfour
- Department of Nursing, Lenmed Group, Johannesburg, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Azraa Cassim
- Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - Sandi L Holgate
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sonya Kolman
- Department of Pharmacy, Nelson Mandela Children's Hospital, Johannesburg, South Africa
| | - Angeliki Messina
- Antimicrobial Stewardship Unit, Netcare Hospitals Ltd, Johannesburg, South Africa
| | - Hafsah Tootla
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Kessendri Reddy
- Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service Tygerberg and Stellenbosch University, Cape Town, South Africa
| | - Shakti Pillay
- Division of Neonatology, Department of Paediatrics and Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Lucinda Conradie
- Pharmacy Department, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Anika M van Niekerk
- Division of Neonatology, Department of Paediatrics and Child Health, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa
| | - Tarina Bester
- Netcare GNE Regional Clinical Pharmacy, Pretoria, South Africa
| | - Pearl Alexander
- Department of Nursing, Lenmed Royal Hospital & Heart Centre, Kimberley, South Africa
| | - Antoinette Andrews
- Department of Nursing, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - Magdel Dippenaar
- Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa
| | - Colleen Bamford
- Pathcare, East London, South Africa; Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sharnel Brits
- Pharmacy Department, George Provincial Hospital, George, South Africa
| | - Pinky Chirwa
- Neonatal Unit, Nelson Mandela Childrens Hospital, Johannesburg, South Africa
| | - Hannelie Erasmus
- Pharmacy Department, Mediclinic Welkom, Welkom, Free State, South Africa
| | - Pieter Ekermans
- Ampath Laboratory, National Reference Laboratory, Department of Medical Microbiology, Pretoria, South Africa
| | - Pebenita Gounden
- Department of Pharmacy, Lenmed Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - Teresa Kriel
- Pharmacy Department, Life Beacon Bay, East London, South Africa
| | - Dini Mawela
- Department of Paediatrics and Child Health, School of Medicine, Sefako Makgatho Health Sciences University, Gauteng, South Africa
| | - Masego Moncho
- Department of Medical Microbiology-National Health Laboratory Services, Sefako Makgatho Health Sciences University, Gauteng, South Africa
| | - Tonia Mphuthi
- Department of Pharmacy, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Ronald Nhari
- Department of Pharmacy, Life Springs Parkland Hospital, Johannesburg, South Africa
| | - Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Pablo J Sánchez
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dena van den Bergh
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Goff DA, Gauthier TP, Langford BJ, Prusakov P, Ubaka Chukwuemka M, Nwomeh BC, Yunis KA, Saad T, van den Bergh D, Villegas MV, Martinez N, Morris A, Ashiru‐Oredope D, Howard P, Sanchez PJ. Global Resilience and New Strategies Needed for Antimicrobial Stewardship during the COVID‐19 Pandemic and Beyond. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:707-715. [PMID: 35572210 PMCID: PMC9087764 DOI: 10.1002/jac5.1622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
Abstract
Resilience is having the ability to respond to adversity proactively and resourcefully. The coronavirus disease 2019 (COVID‐19) pandemic's profound impact on antimicrobial stewardship programs (ASP) requires clinicians to call on their own resilience to manage the demands of the pandemic and the disruption of ASP activities. This article provides examples of ASP resilience from pharmacists and physicians from seven countries with different resources and approaches to ASP—The United States, The United Kingdom, Canada, Nigeria, Lebanon, South Africa, and Colombia. The lessons learned pertain to providing ASP clinical services in the context of a global pandemic, developing new ASP paradigms in the face of COVID‐19, leveraging technology to extend the reach of ASP, and conducting international collaborative ASP research remotely. This article serves as an example of how resilience and global collaboration is sustaining our ASPs by sharing new “how to” do antimicrobial stewardship practices during the COVID‐19 pandemic.
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Affiliation(s)
- Debra A. Goff
- The Ohio State University Wexner Medical Center The Ohio State University College of Pharmacy Columbus Ohio
| | | | | | - Pavel Prusakov
- Nationwide Children's Hospital, Department of Pharmacy Columbus Ohio
| | - M Ubaka Chukwuemka
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka Enugu Nigeria
| | - Benedict C. Nwomeh
- Department of Pediatric Surgery Nationwide Children’s Hospital Columbus Ohio
| | - Khalid A. Yunis
- American University of Beirut, Lebanon, Department of Pediatrics, Division of Neonatology Cape Town South Africa
| | - Therese Saad
- American University of Beirut, Lebanon, Pharmacy Department Cape Town South Africa
| | - Dena van den Bergh
- Division of Infectious Diseases & HIV Medicine Department of Medicine University of Cape Town Cape Town South Africa
| | - Maria Virginia Villegas
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque. Bogotá Colombia
| | | | - Andrew Morris
- Sinai Health System‐University Health Network Toronto Canada
| | - Diane Ashiru‐Oredope
- UK Health Security Agency, London, England; Commonwealth Pharmacists Association; London
| | - Philip Howard
- NHS England and NHS Improvement Quarry House, Quarry Hill Leeds England
| | - Pablo J. Sanchez
- Department of Pediatrics, Divisions of Neonatology and Pediatric Infectious Diseases, Nationwide Children’s Hospital Abigail Wexner Research Institute at Nationwide Children’s Hospital, Center for Perinatal Research Columbus Ohio
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