Determinants of the Effectiveness of Antimicrobial Prophylaxis among Neurotrauma Patients at a Referral Hospital in Kenya: Findings and Implications

BackgroundThe inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is currently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan.MethodsLongitudinal surveillance was conducted over a period of 2 months among hospitals in Lahore, Pakistan. Antibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or both based on the British National Formulary.ResultsA total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately two-thirds of the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had respiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy. Cephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%). Penicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or dosage or both. Significant variations were also observed regarding inappropriate prescribing for several antimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides (74.6%) and other antibacterials (73.1%).ConclusionEducational interventions, institutional guidelines, and antimicrobial stewardship programs need to be developed to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and Government officials are also needed to minimize inappropriate antibiotic use.

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Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications (Preprint)

Schellack¹,

Kruger²,

Dlamini³

et al. 2019

Preprint

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BACKGROUND Determining antimicrobial utilization patterns in hospitals can be a challenge given personnel and resource constraints with paper based systems. A web–based application (APP) was developed in South Africa to address this, building on a recent pilot point prevalence survey (PPS) using a paper-based system. OBJECTIVE The study aim was to test and refine the develop app as well as to evaluate its ease of use and potential time saving versus paper based methods. METHODS The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection phase, the app was evaluated for functionality on all 35 variables and subsequently refined. After the data collection, the app was evaluated in terms of its time saving potential and ease of use. RESULTS 181 patient’s files were surveyed across 13 wards in the hospital, with the findings similar to the paper-based study. The median age for males was 45.5 years and the median age for females was 42 years. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the paediatric medical wards. All the data collectors were confident in using the app after training and found the tool not complex at all. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spending is important for instigating quality improvement programmes in resource limited settings. CONCLUSIONS All data collectors would recommend the app for future PPS surveys. Several concerns with data entry were identified, which have now been addressed in both the refined app as well as in future training. The app development has been successful and is now being deployed across South Africa as part of a national PPS.

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Determinants of the Effectiveness of Antimicrobial Prophylaxis among Neurotrauma Patients at a Referral Hospital in Kenya: Findings and Implications

Cited by 3 publications

References 27 publications

Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future

Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future

Pattern of inappropriate antibiotic use among hospitalized patients in Pakistan: a longitudinal surveillance and implications

Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications (Preprint)

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