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Abejew AA, Wubetu GY, Fenta TG. Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia. Heliyon 2024; 10:e32663. [PMID: 38912506 PMCID: PMC11193037 DOI: 10.1016/j.heliyon.2024.e32663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background Indiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, and financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number of barriers recognized in the implementation of successful ASPs. The aim of this study was to assess health professionals' perceptions and status of ASPs in hospitals in 2022. Methods A cross-sectional study was conducted from September 1, 2022 to October 30, 2022. A total of 181 health professionals were included, and a self-administered questionnaire was used to collect data. The status of hospitals was assessed using a checklist. The data were analyzed using SPSS version 23, and descriptive statistics and Chi-square tests (X2) at a P-value of <0.05 were used. Results Of the 181 respondents, 163 (90.1 %), and 161 (89.0 %) believed that AMR is a significant problem in Ethiopia and globally, respectively. Easy access to antibiotics 155 (85.6 %), and inappropriate use 137 (75.7 %) were perceived as key contributors to AMR. Antibiotics were believed to be prescribed/dispensed without laboratory results 86 (47.5 %), and antibiotic susceptibility patterns were not considered to guide empiric therapy 81 (44.8 %). ASP was believed to reduce the duration of hospital stays and associated costs 137 (75.7 %), and improve the quality of patient care 133 (73.5 %), whereas 151 (83.4 %), 143 (79 %), and 142 (78.5 %) suggested education, institutional guidelines, and prospective audits with feedback interventions to combat AMR in their hospitals, respectively. There were significant differences in perception among professionals based on professional category and attempts by hospitals to implement ASPs. Although ASPs were not functioning according to standard, there have been attempts to implement it in three hospitals. The issue of ASP had never been heard in general hospitals. Currently, it is feasible to implement ASPs in four hospitals. Conclusion The status of ASP in hospitals was very poor. Despite a lack of prior knowledge on ASPs, most respondents do have a positive perception of AMR and the implementation of ASPs. Pharmacist-led prospective audits and feedback with education and institutional guidelines for empiric antibiotic use can be better implemented in hospitals. Involvement of representatives from infection prevention and control, and collaboration among hospitals in ASP implementation will help establish a strong ASP in the area.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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2
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Gashegu M, Gahamanyi N, Ndayambaje FX, Munyemana JB, Ndahindwa V, Lukwago F, Ingabire L, Gambanga F, Gashema P, Tuyishime A, Dzinamarira T, Dukundane D, Muvunyi TZ, Muvunyi CM. Exploring Prescription Practices: Insights from an Antimicrobial Stewardship Program at a Tertiary Healthcare Facility, Rwanda. Antibiotics (Basel) 2024; 13:548. [PMID: 38927214 PMCID: PMC11200619 DOI: 10.3390/antibiotics13060548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Antimicrobial resistance (AMR) is a major public health threat linked to increased morbidity and mortality. It has the potential to return us to the pre-antibiotic era. Antimicrobial stewardship (AMS) programs are recognized as a key intervention to improve antimicrobial use and combat AMR. However, implementation of AMS remains limited in Africa, particularly in Rwanda. This study aimed to assess prescription practices, identify areas for improvement, and promote adherence to AMS principles. Conducted at King Faisal Hospital in Rwanda, this qualitative study used semi-structured interviews with eight participants until saturation was reached. The interviews were recorded, transcribed, and thematically analyzed, revealing four emerging themes. The first theme was on AMS activities that were working well based on availability of microbiology laboratory results and prescription guidelines as factors influencing antibiotic prescription adjustments. The second theme was related to challenges during the implementation of the AMS program, including the prescription of broad-spectrum antibiotics, limited local data on AMR patterns, and stock-outs of essential antibiotics. The third theme was on the importance of adhering to AMR management guidelines at KFH. The last emerged on recommendations from participants centered on regular training for healthcare workers, widespread dissemination of AMR findings across departments, and the enforcement of antibiotic restriction policies. These actions can improve prescription behaviors, upholding the highest standards of patient care, and strengthening the nascent AMS program.
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Affiliation(s)
- Misbah Gashegu
- Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda; (M.G.); (N.G.); (A.T.)
| | - Noel Gahamanyi
- Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda; (M.G.); (N.G.); (A.T.)
- Biology Department, College of Science and Technology, University of Rwanda, Kigali P.O. Box 3900, Rwanda
| | - François Xavier Ndayambaje
- Department of Microbiology and Parasitology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 3286, Rwanda; (F.X.N.); (J.B.M.)
| | - Jean Bosco Munyemana
- Department of Microbiology and Parasitology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 3286, Rwanda; (F.X.N.); (J.B.M.)
| | - Vedaste Ndahindwa
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 3286, Rwanda;
| | - Fredrick Lukwago
- King Faisal Hospital, Kigali P.O Box 2534, Rwanda; (F.L.); (L.I.); (D.D.)
| | - Lambert Ingabire
- King Faisal Hospital, Kigali P.O Box 2534, Rwanda; (F.L.); (L.I.); (D.D.)
| | - Fiona Gambanga
- Clinton Health Access Initiative, Kigali P.O. Box 4062, Rwanda;
| | - Pierre Gashema
- Repolicy Research Centre, Kigali P.O. Box 7584, Rwanda;
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Albert Tuyishime
- Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda; (M.G.); (N.G.); (A.T.)
| | - Tafadzwa Dzinamarira
- International Centre for AIDS Care and Treatment Program, ICAP, Lusaka P.O. Box 34358, Zambia;
| | - Damas Dukundane
- King Faisal Hospital, Kigali P.O Box 2534, Rwanda; (F.L.); (L.I.); (D.D.)
| | | | - Claude Mambo Muvunyi
- Rwanda Biomedical Centre, Kigali P.O. Box 7162, Rwanda; (M.G.); (N.G.); (A.T.)
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali P.O. Box 3286, Rwanda;
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Altaye FW, Thupayagale-Tshweneagae G, Mfidi FH. Qualitative enquiry on factors affecting antibiotic prescribing at primary healthcare facilities in Addis Ababa, Ethiopia. Front Med (Lausanne) 2024; 11:1308699. [PMID: 38651064 PMCID: PMC11034364 DOI: 10.3389/fmed.2024.1308699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Background The major driver of antibiotic resistance is the huge increase in antibiotic prescribing, especially in low- and middle-income countries. Aim This study aimed to explore factors affecting antibiotic prescribing at primary healthcare facilities in Addis Ababa, Ethiopia. Methods The study was part of a three-phased explanatory sequential mixed method design. The study was conducted in five primary healthcare facilities through in-depth interviews of 20 prescribers and 22 key informants using pre-prepared interview guides. The data were analysed through thematic content analysis by applying ATLAS.ti 9 software. Results The antibiotic prescribing decision of prescribers was shown to be affected by various factors. The factors related to prescribers include not updating oneself on antibiotic use and antibiotic resistance, not reviewing patient history, not considering the concerns related to antibiotic resistance during prescribing, and competency problems. The patient-related factors were low awareness about antibiotics, lack of respect for prescribers, and pressure on prescribers. The shortage of antibiotics and laboratory reagents, a lack of updated antimicrobial resistance information, patient load, inadequate capacity, private sector practice, inadequate follow-up and support, and health insurance membership were the system-related factors. Appropriate interventions should be designed and implemented to address the identified factors and improve the prescribing practice.
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Affiliation(s)
| | | | - Faniswa Honest Mfidi
- Department of Health Studies, University of South Africa, Pretoria, South Africa
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4
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Shaker M, Zaki A, Asser SL, Sayed IE. Trends and predictors of antimicrobial resistance among patients with urinary tract infections at a tertiary hospital facility in Alexandria, Egypt: a retrospective record-based classification and regression tree analysis. BMC Infect Dis 2024; 24:246. [PMID: 38389071 PMCID: PMC10885625 DOI: 10.1186/s12879-024-09086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The incidence of Antimicrobial Resistance (AMR) in uropathogens varies between countries and over time. We aim to study the patterns and potential predictors of AMR among patients with UTIs admitted to the Urology Department at Alexandria University Hospital. METHODS An observational retrospective record-based study was conducted on all patients admitted to the Urology department from October 2018 to October 2020. Data collected from patients' records included: demographic data, diagnosis on admission, history of chronic diseases, duration of hospital stay, insertion of a urinary catheter, duration of the catheter in days, history of the use of antibiotics in the previous three months, and history of urinary tract operations. If UTI was documented, we abstracted data about urine culture, use of antibiotics, results of urine cultures, type of organism isolated, and sensitivity to antibiotics. We conducted a multivariable logistic regression model. We performed Classification and Regression Tree Analysis (CART) for predicting risk factors associated with drug resistance among patients with UTI. Data were analyzed using SPSS statistical package, Version 28.0, and R software (2022). RESULTS This study encompassed 469 patients with UTIs. The most commonly isolated bacterium was Escherichia coli, followed by Klebsiella pneumoniae. Multidrug resistance (MDR) was found in 67.7% (149/220) of patients with hospital-acquired UTIs and in 49.4% (83/168) of patients with community-acquired UTIs. Risk factors independently associated with antimicrobial resistance according to logistic regression analysis were the use of antibiotics within three months (AOR = 5.2, 95% CI 2.19-12.31), hospital-acquired UTI (AOR = 5.7, 95% CI 3.06-10.76), diabetes mellitus (AOR = 3.8, 95% CI 1.24-11.84), age over 60 years (AOR = 2.9, 95% CI 1.27-6.72), and recurrent UTI (AOR = 2.6, 95% CI 1.08-6.20). Classification and regression tree (CART) analysis revealed that antibiotic use in the previous three months was the most significant predictor for developing drug resistance. CONCLUSION The study concluded a high level of antimicrobial resistance as well as significant MDR predictors among hospitalized patients with UTIs. It is vital to assess resistance patterns in our hospitals frequently to improve rational antibiotic treatment as well as to sustain antimicrobial stewardship programs and a rational strategy in the use of antibiotics. Empirical therapy for UTI treatment should be tailored to the potential pathogens' susceptibility to ensure optimal treatment. Strategic antibiotic use is essential to prevent further AMR increases. Further research should focus on suggesting new biological systems or designed drugs to combat the resistance of UTI pathogens.
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Affiliation(s)
- Marian Shaker
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Adel Zaki
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sara Lofty Asser
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman El Sayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.
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5
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Rony MKK, Sharmi PD, Alamgir HM. Addressing antimicrobial resistance in low and middle-income countries: overcoming challenges and implementing effective strategies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:101896-101902. [PMID: 37610548 DOI: 10.1007/s11356-023-29434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Antimicrobial resistance (AMR) has become a critical worldwide health crisis. It poses major challenges for healthcare systems across the globe, demanding immediate attention and action. Low and middle-income countries (LMICs), in particular, encounter unique obstacles in addressing AMR due to various factors. This article aims to examine specific challenges and propose effective strategies to combat this issue. Through a comprehensive review of existing literature, this article identifies common barriers and successful interventions in tackling AMR. The research highlights several challenges faced by LMICs in addressing AMR, including limited access to quality healthcare services, socioeconomic disparities, limited awareness, inadequate surveillance systems and data collection, limited regulatory frameworks and quality control, as well as weak healthcare infrastructure and infection prevention practices. The research suggests strategies like improving healthcare access, promoting responsible antimicrobial use, enhancing surveillance, ensuring quality antimicrobial drugs, and fostering global collaboration to address these challenges. By understanding the challenges encountered by LMICs, it is possible to mitigate the impact of AMR and contribute to global efforts in combating this growing threat.
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Affiliation(s)
- Moustaq Karim Khan Rony
- Masters of Public Health, Bangladesh Open University, Dhaka, Bangladesh.
- University of Dhaka, Dhaka, Bangladesh.
| | - Priyanka Das Sharmi
- College of Nursing, International University of Business Agriculture and Technology, Dhaka, Bangladesh
| | - Hasnat M Alamgir
- Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh
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Huang S, Eze UA. Awareness and Knowledge of Antimicrobial Resistance, Antimicrobial Stewardship and Barriers to Implementing Antimicrobial Susceptibility Testing among Medical Laboratory Scientists in Nigeria: A Cross-Sectional Study. Antibiotics (Basel) 2023; 12:antibiotics12050815. [PMID: 37237717 DOI: 10.3390/antibiotics12050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is now considered one of the greatest global health threats. This is further compounded by a lack of new antibiotics in development. Antimicrobial stewardship programmes can improve and optimize the use of antibiotics, thereby increasing the cure rates of antibiotic treatment and decreasing the problem of AMR. In addition, diagnostic and antimicrobial stewardships in the pathology laboratories are useful tools to guide clinicians on patient treatment and to stop the inappropriate use of antibiotics in empirical treatment or narrow antibiotics. Medical Laboratory Scientists are at the forefront of performing antibiotics susceptibility testing in pathology laboratories, thereby helping clinicians to select the appropriate antibiotics for patients suffering from bacterial infections. Methods: This cross-sectional study surveyed personal antimicrobial usage, the knowledge and awareness on AMR, and antimicrobial stewardship, as well as barriers to antimicrobial susceptibility testing among medical laboratory scientists in Nigeria using pre-tested and validated questionnaires administered online. The raw data were summarized and exported in Microsoft Excel and further analyzed using IBM SPSS version 26. Results: Most of the respondents were males (72%) and 25-35 years old (60%). In addition, the BMLS degree was the highest education qualification most of the respondents (70%) achieved. Of the 59.2% of the respondents involved in antibiotics susceptibility testing, the disc diffusion method was the most commonly used (67.2%), followed by PCR/Genome-based detection (5.2%). Only a small percentage of respondents used the E-test (3.4%). The high cost of testing, inadequate laboratory infrastructure, and a lack of skilled personnel are the major barriers to performing antibiotics susceptibility testing. A higher proportion of a good AMR knowledge level was observed in male respondents (75%) than females (42.9%). The knowledge level was associated with the respondent's gender (p = 0.048), while respondents with a master's degree were more likely to possess a good knowledge level of AMR (OR: 1.69; 95% CI: 0.33, 8.61). Conclusion: The findings of this study indicate that Nigerian medical laboratory scientists had moderate awareness of AMR and antibiotic stewardship. It is necessary to increase investments in laboratory infrastructure and manpower training, as well as set up an antimicrobial stewardship programme to ensure widespread antibiotics susceptibility testing in hospitals, thereby decreasing empirical treatment and the misuse of antibiotics.
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Affiliation(s)
- Sheng Huang
- School of Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry CV1 5FB, UK
| | - Ukpai A Eze
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, UK
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7
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Obasanya JO, Ogunbode O, Landu-Adams V. An appraisal of the contextual drivers of successful antimicrobial stewardship implementation in Nigerian health care facilities. J Glob Antimicrob Resist 2022; 31:141-148. [PMID: 35973672 DOI: 10.1016/j.jgar.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) is a consequence of inappropriate actions, including irrational antimicrobial prescribing and use. Antimicrobial resistance remains an emergent and significant public health threat, particularly in low and middle-income countries (LMICs), including Nigeria. Optimizing antimicrobial (AM) use through functional hospital antimicrobial stewardship (AMS) programs is one of the strategies to control the spread of AMR. Literature is replete with evidence, but few studies examined the contextual factors limiting AMS functionality at the facility levels. This study explored the intrinsic contextual factors shaping AMS practice at the three-tiered levels of care. METHODS This was a qualitative case study with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. RESULTS Emergent themes include lack of AMS programs, inadequate guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. These findings demonstrate that the AMS program is lacking or poorly implemented at the three-tiered level of care. CONCLUSION We recommended that health facilities establish AMS programs in line with the World Health Organization's stepwise approach. These challenges, if addressed, will promote the successful performance of the AMS program, contributing to rational AM use at all levels of care. Since primary health centres constitute 85.4% of all health facilities, customizing the AMS core elements at this level will contribute to achieving the goals of universal health coverage.
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8
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Showande SJ, Ikuomola IF. Pharmacists’ involvement with and pharmacy clients’ awareness of adverse drug reaction reporting in Nigeria – a mixed-methods approach. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
Adverse drug reactions are one of the leading causes of death, yet they are under-reported. This study assessed the involvement of community pharmacists in the identification, documentation, and reporting of adverse drug reactions and pharmacy clients’ awareness of the adverse drug reaction reporting system.
Methods
A cross-sectional questionnaire-guided survey was conducted among 780 pharmacy clients in six selected community pharmacies, and seven mystery clients visited 125 community pharmacies in Ibadan, Nigeria. Information on pharmacy clients’ experience of adverse drug reactions, to whom and how they were reported, was obtained. Female and male mystery clients’ performed two scripted scenarios, complaining of black patches on their thighs and blood in their faeces, respectively. The proportion of pharmacists who identified the complaints as adverse drug reactions, documented and reported them, was described.
Key findings
The response rate for the pharmacy clients’ survey was 98.5%. Some pharmacy clients, 385 (50.1%), had experienced adverse drug reactions; 49 (12.7%) of these pharmacy clients were hospitalised and 73 (19.0%) of them reported the adverse drug reactions to physicians or pharmacists. Most of the pharmacy clients, 706 (91.9%), did not use the available reporting system. A total of 218 mystery client visits were made. The proportion of pharmacists who recognised the mystery client complaints as adverse drug reactions was 4.9–60.3% depending on the scenario presented and up to two pharmacists documented and supposedly reported the adverse drug reactions.
Conclusions
Some of the pharmacy clients reported experiencing adverse drug reactions to healthcare professionals, but most did not report through the existing reporting scheme. Community pharmacists could identify adverse drug reactions but most failed to document or report them.
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Affiliation(s)
- Segun Johnson Showande
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan , Ibadan , Nigeria
| | - Iretomiwa Faith Ikuomola
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan , Ibadan , Nigeria
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9
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Chotiprasitsakul D, Bruminhent J, Watcharananan SP. Current state of antimicrobial stewardship and organ transplantation in Thailand. Transpl Infect Dis 2022; 24:e13877. [DOI: 10.1111/tid.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Darunee Chotiprasitsakul
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
| | - Jackrapong Bruminhent
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
| | - Siriorn P. Watcharananan
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
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Amos D. Conducting research by mixed methods: an autoethnography account of a PhD research in facilities management from a developing country. FACILITIES 2022. [DOI: 10.1108/f-12-2021-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite the increasing discourse on mixed methods (MM) in academic literature, less attention has been focused on its methodological development in the built environment in developing countries. This paper aims to examine the basis and challenges of the application of MM for health-care facilities management (FM) research in Ghana.
Design/methodology/approach
This paper adopts autoethnography as its research method, coupled with a scholarly review of methodological literature to position a technical view on the application of mixed methods for health-care FM research in a developing country.
Findings
This paper contributes and lends support to the methodological strength of MM as epistemologically coherent and useful for understanding the intricacies of health-care FM. This paper advances the proposition that the nascent stage of FM development in Ghana, paucity of literature, epistemological and axiological considerations underscore the choice of a sequential MM. The attitude of research participants, ethical challenges and time-lapse for data analysis were observed as practical challenges.
Research limitations/implications
Discussion of data integration is excluded.
Practical implications
This paper provides a nuanced understanding of the concept of MM in health-care FM and set forth practical recommendations worthy to enhance the application of MM research.
Originality/value
This paper is among the few focusing on methodological discussion of health-care FM. This paper proposes a framework to guide researchers in the application of mixed methods.
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Siribhadra A, Ngamprasertchai T, Rattanaumpawan P, Lawpoolsri S, Luvira V, Pitisuttithum P. Antimicrobial Stewardship in Tropical Infectious Diseases: Focusing on Dengue and Malaria. Trop Med Infect Dis 2022; 7:tropicalmed7080159. [PMID: 36006251 PMCID: PMC9412681 DOI: 10.3390/tropicalmed7080159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Acute undifferentiated febrile illness (AUFI) is the presenting symptom of various tropical and infectious diseases. Viral infection is generally the most common cause of AUFI, accounting for 8–11.8% of cases; thus, antibiotics might be unnecessary. Dengue and malaria are common tropical infectious diseases requiring effective supportive treatment and antimalarial agents, respectively. The uncertainty of early diagnosis results in widespread empirical antimicrobial treatment in high -income as well as in low-and middle-income countries. Although rapid diagnostic tests (RDTs) have been shown to limit antibiotic prescriptions in dengue and malaria, we observed a wide range of antibiotic prescriptions for 13–92.7% of cases in previous literature, particularly in RDT-negative malaria cases. Given several RDT limitations, antimicrobial stewardship (AMS) appears to be an effective strategy for controlling unnecessary antibiotic use and antimicrobial resistance (AMR) prevention. This program should be endorsed by a multidisciplinary team in tropical diseases to control collateral damage of inappropriate antimicrobial use. Empirical antibiotic treatment should be administered based on clinical judgement, microbiological evidence, and local epidemiological data. Rapid termination of antibiotic therapy, including disease control or elimination, is the mainstay of AMS in tropical diseases. Local and international sectors should implement an AMS programme to reduce AMR in the Tropics.
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Affiliation(s)
- Ashley Siribhadra
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (A.S.); (V.L.); (P.P.)
| | - Thundon Ngamprasertchai
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (A.S.); (V.L.); (P.P.)
- Correspondence:
| | - Pinyo Rattanaumpawan
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand;
| | - Viravarn Luvira
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (A.S.); (V.L.); (P.P.)
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; (A.S.); (V.L.); (P.P.)
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Alabi AS, Picka SW, Sirleaf R, Ntirenganya PR, Ayebare A, Correa N, Anyango S, Ekwen G, Agu E, Cook R, Yarngrorble J, Sanoe I, Dugulu H, Wiefue E, Gahn-Smith D, Kateh FN, Hallie EF, Sidonie CG, Aboderin AO, Vassellee D, Bishop D, Lohmann D, Naumann-Hustedt M, Dörlemann A, Schaumburg F. Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned. JAC Antimicrob Resist 2022; 4:dlac069. [PMID: 35769809 PMCID: PMC9226657 DOI: 10.1093/jacamr/dlac069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs). Objectives To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals. Methods A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use. Results The majority of patients had skin and soft tissue infections (n = 108) followed by surgical site infections (n = 72), pneumonia (n = 64), urinary tract infection (n = 48) and meningitis (n = 18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, P < 0.0005), dosage (from 15.2% to 36.5%, P < 0.0005) and duration (from 13.2% to 31.0%, P < 0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P < 0.0005). Conclusions AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.
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Affiliation(s)
- Abraham S Alabi
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Stephen W Picka
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Reubvera Sirleaf
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | | | - Arnold Ayebare
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | | | - Sarah Anyango
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | - Gerald Ekwen
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | - Emmanuel Agu
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | - Rebecca Cook
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
- Partners In Health, Boston, MA, USA
| | | | - Ibrahim Sanoe
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | - Henry Dugulu
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | | | | | | | | | | | | | - David Vassellee
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | - Damien Bishop
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | - Daniel Lohmann
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | | | - Alois Dörlemann
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University of Münster, Münster, Germany
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Dohou AM, Buda VO, Yemoa LA, Anagonou S, Van Bambeke F, Van Hees T, Dossou FM, Dalleur O. Antibiotic Usage in Patients Having Undergone Caesarean Section: A Three-Level Study in Benin. Antibiotics (Basel) 2022; 11:617. [PMID: 35625261 PMCID: PMC9137971 DOI: 10.3390/antibiotics11050617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 01/17/2023] Open
Abstract
The intense use and misuse of antibiotics is undoubtedly the main factor associated with the high numbers of antibiotic-resistant pathogenic and commensal bacteria worldwide. In low-income countries, this misuse and overuse is widespread, with great consequences at the personal and global levels. In the context of user fee exemptions in caesarean sections, we performed a descriptive study in women to assess the use of antibiotics on three levels-antenatal, during caesarean section, and postpartum-in four Beninese hospitals. Out of the 141 women included, 56.7% were using antibiotics. More than the half (71.3%) were taking more than one antibiotic, either for a long time or in acute treatment. In prophylaxis, the timing, dose, and duration of administration were not correctly achieved. Only 31.2% of women received optimal antibiotic prophylaxis. Various antibiotics including broad-spectrum molecules were used in the patients after caesarean section. The use of antibiotics was improper on the three levels studied. The high rate of self-administered antibiotics, the poor achievement of antibiotic prophylaxis, and the postpartum overuse of antibiotics showed a poor quality of care provided in pregnancy. A national policy is essential to improve the use of antibiotics by the general public as well as by professionals.
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Affiliation(s)
- Angèle Modupè Dohou
- Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium; (F.V.B.); (O.D.)
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (L.A.Y.); (S.A.); (F.M.D.)
| | - Valentina Oana Buda
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Loconon Achille Yemoa
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (L.A.Y.); (S.A.); (F.M.D.)
| | - Severin Anagonou
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (L.A.Y.); (S.A.); (F.M.D.)
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium; (F.V.B.); (O.D.)
| | - Thierry Van Hees
- Center for Interdisciplinary Research on Medicines, Université de Liège, Place du 20 Août 7, 4000 Liège, Belgium;
| | - Francis Moïse Dossou
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (L.A.Y.); (S.A.); (F.M.D.)
| | - Olivia Dalleur
- Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium; (F.V.B.); (O.D.)
- Service de Pharmacie Clinique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
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Knowledge, Awareness and Practice with Antimicrobial Stewardship Programmes among Healthcare Providers in a Ghanaian Tertiary Hospital. Antibiotics (Basel) 2021; 11:antibiotics11010006. [PMID: 35052883 PMCID: PMC8773036 DOI: 10.3390/antibiotics11010006] [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: 11/12/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 12/31/2022] Open
Abstract
Antimicrobial resistance (AMR) is a significant problem in global health today, particularly in low- and middle-income countries (LMICs) where antimicrobial stewardship programmes are yet to be successfully implemented. We established a partnership between AMR pharmacists from a UK NHS hospital and in Ho Teaching Hospital with the aim of enhancing antimicrobial stewardship knowledge and practice among healthcare providers through an educational intervention. We employed a mixed-method approach that included an initial survey on knowledge and awareness before and after training, followed by qualitative interviews with healthcare providers conducted six months after delivery of training. This study was carried out in two phases in Ho Teaching Hospital with healthcare professionals, including pharmacists, medical doctors, nurses and medical laboratory scientists. Ethical approval was obtained prior to data collection. In the first phase, we surveyed 50 healthcare providers, including nurses (33%), pharmacists (29%) and biomedical scientists (23%). Of these, 58% of participants had engaged in continuous professional development on AMR/AMS, and above 95% demonstrated good knowledge on the general use of antibiotics. A total of 18 participants, which included four medical doctors, five pharmacists, four nurses, two midwives and three biomedical scientists, were interviewed in the second phase and demonstrated greater awareness of AMS practices, particularly the role of education for patients, as well as healthcare professionals. We found that knowledge and practice with AMS was markedly improved six months after the training session. There is limited practice of AMS in LMICs; however, through AMR-focused training, we demonstrated improved AMS skills and practice among healthcare providers in Ho Teaching Hospital. There is a need for continuous AMR training sessions for healthcare professionals in resource-limited settings.
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15
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Iheanacho CO, Eze UIH. A systematic review of in-patients’ antimicrobial prescriptions and status of antimicrobial stewardship programmes in Nigerian hospitals. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00365-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Antimicrobial resistance is a major consequence of irrational antimicrobial prescriptions and consumptions, but this can be prevented by antimicrobial stewardship. The study systematically reviewed available evidence on antimicrobial prescriptions and antimicrobial stewardship (AMS) programmes in Nigerian hospitals. This will provide insight to the extent of required interventions, for improved healthcare.
Main body
Published research from January 1 2010 to March 31 2021 from PubMed, Scopus, Web of Science, African Journals Online and Google scholar databases was reviewed using Preferred Regulatory Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2009. Studies that reported antimicrobial use and antimicrobial stewardship programmes in Nigerian hospitals within the period in focus were assessed for eligibility. The National Heart, Lung and Blood Institute (NHLBI) quality assessment tool was used to assess quality of included studies. Among 15 studies included based on inclusion criteria, 12 reported on antimicrobial prescriptions and 3 reported on status of antimicrobial stewardship programmes in Nigerian hospitals. Most studies reported high prevalence of antimicrobials prescriptions with broad spectrum antimicrobials, majority of which were inappropriate. Empirical antimicrobial prescribing was common, and this was mostly done with less cognisance to existing guidelines. Only few hospitals were observed to have formal AMS teams in Nigeria.
Conclusion
Inappropriate prescribing of antimicrobials was common among prescribers in Nigeria. Although there was paucity of studies on status of AMS, the available few showed very low prevalence of AMS teams in hospitals. There is urgent need for implementation of AMS in Nigerian hospitals, to enhance rational antimicrobial use. Meanwhile more research on AMS in Nigerian hospitals is needed.
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16
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Porter GJ, Owens S, Breckons M. A systematic review of qualitative literature on antimicrobial stewardship in Sub-Saharan Africa. Glob Health Res Policy 2021; 6:31. [PMID: 34412692 PMCID: PMC8377884 DOI: 10.1186/s41256-021-00216-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a major problem in every region of the globe and Sub-Saharan Africa (SSA) is no exception. Several systematic reviews have addressed the prevalence of resistant organisms but few have examined the underlying causes in this region. This systematic review of qualitative literature aims to highlight barriers and facilitators to antimicrobial stewardship in SSA. METHODS A literature search of Embase and MEDLINE(R) was carried out. Studies were included if they were in English, conducted in SSA, and reported qualitative data on the barriers and facilitators of antimicrobial stewardship or on attitudes towards resistance promoting behaviours. Studies were screened with a simple critical appraisal tool. Secondary constructs were extracted and coded into concepts, which were then reviewed and grouped into themes in light of the complete dataset. RESULTS The literature search yielded 169 results, of which 14 studies from 11 countries were included in the final analysis. No studies were excluded as a result of the critical appraisal. Eight concepts emerged from initial coding, which were consolidated into five major themes: ineffective regulation, health system factors, clinical governance, patient factors and lack of resources. The ineffective regulation theme highlighted the balance between tightening drugstore regulation, reducing over-the-counter sale of antibiotics, and maintaining access to medicines for rural communities. Meanwhile, health system factors explored the tension between antimicrobial stewardship and the need of pharmacy workers to maintain profitable businesses. Additionally, a lack of resources, actions by patients and the day-to-day challenges of providing healthcare were shown to directly impede antimicrobial stewardship and exacerbate other factors which promote resistance. CONCLUSION Antibiotic resistance in SSA is a multi-faceted issue and while limited resources contribute to the problem they should be viewed in the context of other factors. We identify several contextual factors that affect resistance and stewardship that should be considered by policy makers when planning interventions. This literature base is also incomplete, with only 11 nations accounted for and many studies being confined to regions within countries, so more research is needed. Specifically, further studies on implementing stewardship interventions, successful or not, would be beneficial to inform future efforts.
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Affiliation(s)
- George James Porter
- Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK.
| | - Stephen Owens
- Department of Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
| | - Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Framlington Place, Newcastle Upon Tyne, UK
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17
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Ogunleye OO, Oyawole MR, Odunuga PT, Kalejaye F, Yinka-Ogunleye AF, Olalekan A, Ogundele SO, Ebruke BE, Kalada Richard A, Anand Paramadhas BD, Kurdi A, Sneddon J, Seaton A, Godman B. A multicentre point prevalence study of antibiotics utilization in hospitalized patients in an urban secondary and a tertiary healthcare facilities in Nigeria: findings and implications. Expert Rev Anti Infect Ther 2021; 20:297-306. [PMID: 34128756 DOI: 10.1080/14787210.2021.1941870] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The understanding of antimicrobial utilization patterns is pertinent to successful implementation of the National Action Plans on Antimicrobial Resistance (AMR). There is, however, limited information on antibiotics utilization in Nigeria. This study was undertaken to build on existing information and provide direction for appropriate interventions including Antibiotics Stewardship Programs (ASP). METHOD A Point Prevalence Study (PPS) was conducted in two public urban health facilities in Lagos, Nigeria using a design adapted from the European Center for Disease Prevention and Control (ECDC) and Global-PPS surveys. RESULTS The prevalence of antibiotics use was 80.6% administered mostly parenterally (83.1% of total prescriptions) with concerns with extended surgical antibiotics prophylaxis. The mostly used antibiotics in the secondary hospital were parenteral metronidazole (32.4%), ceftriaxone (27.5%), and amoxicillin + clavulanate (8.2%) while the mostly used in the tertiary hospital were ceftriaxone (25.3%), parenteral metronidazole (19.1%), and amoxicillin + clavulanate (9.3%). There was an appreciable lack of specific functional capacities, policies, and processes to promote appropriate antimicrobial use in both hospitals. CONCLUSIONS There is high rate of antibiotics utilization in these facilities with lack of institutional frameworks and processes for ensuring appropriate antibiotic use. The study provides the information needed to improve future antimicrobial use in hospitals and reduce AMR.
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Affiliation(s)
- Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Modupe R Oyawole
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Patricia T Odunuga
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Folasade Kalejaye
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Adesola F Yinka-Ogunleye
- Nigerian Centre for Disease Control, Federal Capital Territory, Abuja, Nigeria.,Institute of Global Health, University College, London, UK
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos, Nigeria.,Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos, Nigeria
| | - Sunday O Ogundele
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Diseases In Nigeria (IFAIN), Abuja, Nigeria
| | | | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Andrew Seaton
- Healthcare Improvement Scotland, Delta House, Glasgow, UK.,Queen Elizabeth University Hospital, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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18
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Zhao H, Wei L, Li H, Zhang M, Cao B, Bian J, Zhan S. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. THE LANCET. INFECTIOUS DISEASES 2021; 21:847-857. [PMID: 33515511 DOI: 10.1016/s1473-3099(20)30596-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/24/2020] [Accepted: 07/10/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship. METHODS We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported. FINDINGS Between Oct 1, 2014, and April 30, 2018, 18 848 864 (10·9%) of 172 704 117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18 848 864 antibiotic prescriptions, 9 689 937 (51·4%) were inappropriate, 5 354 224 (28·4%) were potentially appropriate, 2 893 102 (15·3%) were appropriate, and 911 601 (4·8%) could not be linked to any diagnosis. A total of 23 266 494 individual antibiotics were prescribed, of which 18 620 086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5 056 058 [21·7%]), second-generation cephalosporins (3 823 410 [16·4%]), macrolides (3 554 348 [15·3%]), and fluoroquinolones (3 285 765 [14·1%]). INTERPRETATION Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. FUNDING The National Natural Science Foundation of China.
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Affiliation(s)
- Houyu Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Mei Zhang
- Department of Pharmacology, 7th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jiaming Bian
- Department of Pharmacology, 7th Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
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19
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Rolfe R, Kwobah C, Muro F, Ruwanpathirana A, Lyamuya F, Bodinayake C, Nagahawatte A, Piyasiri B, Sheng T, Bollinger J, Zhang C, Ostbye T, Ali S, Drew R, Kussin P, Anderson DJ, Woods CW, Watt MH, Mmbaga BT, Tillekeratne LG. Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study. Antimicrob Resist Infect Control 2021; 10:60. [PMID: 33766135 PMCID: PMC7993456 DOI: 10.1186/s13756-021-00929-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). METHODS Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. RESULTS Barriers to improving antimicrobial prescribing included prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to changing current practices regarding antimicrobial prescribing, and limited diagnostic capabilities. The most frequent of these barriers in all three locations was limited drug availability. Many physicians in all three sites had not heard of ASPs before the interviews. Improved education was a suggested component of ASPs at all three sites. The creation of guidelines was also recommended, without prompting, by interviewees at all three sites. Although most participants felt microbiological results were helpful in tailoring antibiotic courses, some expressed distrust of laboratory culture results. Biomarkers like erythrocyte sedimentation rate and c-reactive protein were not felt to be specific enough to guide antimicrobial therapy. Despite limited or no prior knowledge of ASPs, most interviewees were receptive to implementing protocols that would include documentation and consultation with ASPs regarding antimicrobial prescribing. CONCLUSIONS Our study highlighted several important barriers to implementing ASPs that were shared between three tertiary care centers in LMICs. Improving drug availability, enhancing availability of and trust in microbiologic data, creating local guidelines, and providing education to physicians regarding antimicrobial prescribing are important steps that could be taken by ASPs in these facilities.
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Affiliation(s)
- Robert Rolfe
- Duke University, Durham, NC, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Charles Kwobah
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Florida Muro
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Furaha Lyamuya
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Champica Bodinayake
- Duke Global Health Institute, Durham, NC, USA
- University of Ruhuna, Galle, Sri Lanka
| | - Ajith Nagahawatte
- Duke Global Health Institute, Durham, NC, USA
- University of Ruhuna, Galle, Sri Lanka
| | | | | | | | - Chi Zhang
- Duke Global Health Institute, Durham, NC, USA
| | | | - Shamim Ali
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Richard Drew
- Duke University, Durham, NC, USA
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | | | - Deverick J Anderson
- Duke University, Durham, NC, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Christopher W Woods
- Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Blandina T Mmbaga
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - L Gayani Tillekeratne
- Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
- University of Ruhuna, Galle, Sri Lanka
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20
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Samuels R, Qekwana DN, Oguttu JW, Odoi A. Antibiotic prescription practices and attitudes towards the use of antimicrobials among veterinarians in the City of Tshwane, South Africa. PeerJ 2021; 9:e10144. [PMID: 33520429 PMCID: PMC7811296 DOI: 10.7717/peerj.10144] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Understanding the prescription practices and attitudes of veterinarians towards antimicrobial resistance (AMR) is crucial in guiding efforts to curb AMR. This study investigated prescription practices and attitudes towards AMR among veterinarians in the City of Tshwane, South Africa. METHODS Out of the 83 veterinarians invited to participate in the study, 54 signed the consent form and completed the questionnaire. Percentages and 95% confidence intervals of all categorical variables were computed. A multinomial logistic model was used to identify predictors of the veterinarians' view towards antimicrobial use. RESULTS The majority (88%) of respondents indicated that improper use of antimicrobials contributed to selection for AMR. Veterinarians relied on clinical signs and symptoms (88%, 48/54) to decide whether to prescribe antimicrobials or not. However, the choice of antimicrobials depended on the cost of antibiotics (77.2%), route of administration (81.5%), and risk of potential adverse reactions (79.6%; 43/54). Many (61.5%) veterinarians were of the view that often antimicrobials are appropriately prescribed and 88.7% agreed that improper use of antimicrobials contributed to selection for antimicrobial resistant organisms. Compared to females, males were significantly more likely (Relative Risk Ratio (RRR) = 9.0; P = 0.0069) to agree rather than to "neither agree nor disagree" that their colleagues over-prescribed antimicrobials. CONCLUSIONS The decisions to prescribe antimicrobials by the veterinarians depended on clinical presentation of the patient, while the choice of antimicrobial depended on cost, route of administration, and risk of potential adverse reactions. Most veterinarians were of the view that antimicrobials were prescribed judiciously.
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Affiliation(s)
- Ronita Samuels
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
| | - Daniel Nenene Qekwana
- Section of Veterinary Public Health, Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - James W. Oguttu
- Department of Agriculture and Animal Health, College of Agriculture & Environmental Sciences, University of South Africa, Johannesburg, South Africa
| | - Agricola Odoi
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA
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Majumder MAA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, Gittens-St Hilaire M. Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health. Infect Drug Resist 2020; 13:4713-4738. [PMID: 33402841 PMCID: PMC7778387 DOI: 10.2147/idr.s290835] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Infections with multidrug-resistant (MDR) bacteria also have substantial implications on clinical and economic outcomes. Moreover, increased indiscriminate use of antibiotics during the COVID-19 pandemic will heighten bacterial resistance and ultimately lead to more deaths. This review highlights AMR's scale and consequences, the importance, and implications of an antimicrobial stewardship program (ASP) to fight resistance and protect global health. Antimicrobial stewardship (AMS), an organizational or system-wide health-care strategy, is designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness, along with the promotion and protection of public health. ASP has been very successful in promoting antimicrobials' appropriate use by implementing evidence-based interventions. The "One Health" approach, a holistic and multisectoral approach, is also needed to address AMR's rising threat. AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR. Evidence-based policies must guide the "One Health" approach, vaccination protocols, health professionals' education, and the public's awareness about AMR.
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Affiliation(s)
- Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Damian Cohall
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
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Rivera-Izquierdo M, Benavente-Fernández A, López-Gómez J, Láinez-Ramos-Bossini AJ, Rodríguez-Camacho M, Valero-Ubierna MDC, Martín-delosReyes LM, Jiménez-Mejías E, Moreno-Roldán E, Lardelli-Claret P, Martínez-Ruiz V. Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:E324. [PMID: 32545738 PMCID: PMC7345506 DOI: 10.3390/antibiotics9060324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, 18016 Granada, Spain;
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Programme in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Spain;
| | - Alberto Benavente-Fernández
- Service of Internal Medicine, Hospital Universitario San Cecilio, 18016 Granada, Spain; (A.B.-F.); (J.L.-G.)
| | - Jairo López-Gómez
- Service of Internal Medicine, Hospital Universitario San Cecilio, 18016 Granada, Spain; (A.B.-F.); (J.L.-G.)
| | | | | | | | - Luis Miguel Martín-delosReyes
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Elena Moreno-Roldán
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
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