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Chang FY, Chuang YC, Veeraraghavan B, Apisarnthanarak A, Tayzon MF, Kwa AL, Chiu CH, Deris ZZ, Amir Husin S, Hashim H, Karuniawati A, Ahmed A, Matsumoto T, Nguyen VK, Dinh TTH. Gaps in antimicrobial stewardship programmes in Asia: a survey of 10 countries. JAC Antimicrob Resist 2022; 4:dlac117. [PMID: 36439993 PMCID: PMC9683392 DOI: 10.1093/jacamr/dlac117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/25/2022] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES To determine antimicrobial stewardship (AMS) programme practices in Asian secondary- and tertiary-care hospitals. METHODS AMS programme team members within 349 hospitals from 10 countries (Cambodia, India, Indonesia, Japan, Malaysia, Pakistan, the Philippines, Taiwan, Thailand and Vietnam) completed a questionnaire via a web-based survey link. The survey contained questions as to whether 12 core components deemed essential for AMS programmes were implemented. RESULTS Overall, 47 (13.5%) hospitals fulfilled all core AMS programme components. There was a mean positive response rate (PRR) of 85.6% for the responding countries in relation to a formal hospital leadership statement of support for AMS activities, but this was not matched by budgeted financial support for AMS activities (mean PRR 57.1%). Mean PRRs were ≥80.0% for the core AMS team comprising a physician or other leader responsible for AMS activities, a pharmacist and infection control and microbiology personnel. Most hospitals had access to a timely and reliable microbiology service (mean PRR 90.4%). Facility-specific antibiotic treatment guidelines for common infections (mean PRR 78.7%) were in place more often than pre-authorization and/or prospective audit and feedback systems (mean PRR 66.5%). In terms of AMS monitoring and reporting, PRRs of monitoring specific antibiotic use, regularly publishing AMS outcome measures, and the existence of a hospital antibiogram were 75.1%, 64.4% and 77.9%, respectively. CONCLUSIONS Most hospitals participating in this survey did not have AMS programmes fulfilling the requirements for gold standard AMS programmes in hospital settings. Urgent action is required to address AMS funding and resourcing deficits.
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Affiliation(s)
- Feng-Yee Chang
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yin Ching Chuang
- Medical Research Department, Chi Mei Medical Center, Tainan City, Taiwan
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
| | | | - Maria Fe Tayzon
- Department of Medicine, Section of Infectious Diseases, Hospital Infection Control and Epidemiology Center, The Medical City, Pasig City, Philippines
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Cheng-Hsun Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Zakuan Zainy Deris
- Department of Medical Microbiology and Parasitology, School of Medical Sciences/Hospital Universiti Sains Malaysia, USM Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Suraya Amir Husin
- Medical Development Division, Ministry of Health, Putrajaya, Malaysia
| | - Hazimah Hashim
- Pharmacy Practice and Development Division, Ministry of Health, Petaling Jaya, Malaysia
| | - Anis Karuniawati
- Department of Microbiology, Medical Faculty, Universitas Indonesia, Jakarta, Indonesia
| | - Altaf Ahmed
- Department of Pathology/Microbiology, Pakistan Kidney and Liver Institute, Lahore, Pakistan
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, International University of Health and Welfare, Chiba-ken, Japan
| | - Van Kinh Nguyen
- Infectious Diseases Department, Hanoi Medical University, Hanoi, Vietnam
| | - Thi Thu Huong Dinh
- Emergency Department - Infection Control, National Hospital for Tropical Diseases, Hanoi, Vietnam
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Mubarak N, Khan AS, Zahid T, Ijaz UEB, Aziz MM, Khan R, Mahmood K, Saif-ur-Rehman N, Zin CS. Assessment of Adherence to the Core Elements of Hospital Antibiotic Stewardship Programs: A Survey of the Tertiary Care Hospitals in Punjab, Pakistan. Antibiotics (Basel) 2021; 10:antibiotics10080906. [PMID: 34438956 PMCID: PMC8388777 DOI: 10.3390/antibiotics10080906] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/11/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of "YES", "NO" or "Under Process" constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated "Perfect" adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were "Poor" in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes.Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or "Under Process". The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan.
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Affiliation(s)
- Naeem Mubarak
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
- Correspondence: (N.M.); (N.S.-u.-R.); (C.S.Z.)
| | - Asma Sarwar Khan
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
| | - Taheer Zahid
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
| | - Umm e Barirah Ijaz
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
| | - Muhammad Majid Aziz
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
| | - Rabeel Khan
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
| | - Khalid Mahmood
- Institute of Information Management, University of the Punjab, Lahore 54000, Pakistan;
| | - Nasira Saif-ur-Rehman
- Department of Pharmacy Practice, Lahore Medical & Dental College, University of Health Sciences, Lahore 54600, Pakistan; (A.S.K.); (T.Z.); (U.e.B.I.); (M.M.A.); (R.K.)
- Correspondence: (N.M.); (N.S.-u.-R.); (C.S.Z.)
| | - Che Suraya Zin
- Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia
- Correspondence: (N.M.); (N.S.-u.-R.); (C.S.Z.)
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de Wilde S, Pot JLW, Buijtels PCAM, Nagtegaal JE. Improving accurate antimicrobial use for complicated urinary tract infections by antibiotic stewardship intervention. Infect Dis (Lond) 2020; 53:139-141. [PMID: 33245248 DOI: 10.1080/23744235.2020.1842490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- S de Wilde
- Department Hospital Pharmacy, Meander Medical Center, Amersfoort, the Netherlands
| | - J L W Pot
- Department Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P C A M Buijtels
- Department of Clinical Microbiology, Meander Medical Center, Amersfoort, the Netherlands
| | - J E Nagtegaal
- Department Hospital Pharmacy, Meander Medical Center, Amersfoort, the Netherlands
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