Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: a pilot study and implications

Dlamini, Nokuthula; Meyer, Johanna Catharina; Kruger, Danie; Kurdi, Amanj; Godman, Brian; Schellack, Natalie

doi:10.1080/21548331.2019.1592880

Cited by 34 publications

(53 citation statements)

References 43 publications

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“…There was a high prevalence of infections (70.6%) among inpatients treated in the hospitals in Botswana with antimicrobials. This prevalence was similar to one hospital in Kenya (67.7%) as well as hospitals in Pakistan (77.6%) but higher than other hospitals in Kenya (54.7%) as well as Ghana (51.4%) and South Africa (31% and 38.5%) [39][40][41]45,52,81]. In addition, higher than the findings of the Global PPS with an overall prevalence of 34.4%, up to 50.0% among the 12 participating hospitals in five African countries [46].…”

Section: Discussionsupporting

confidence: 68%

“…This high prevalence in Botswana may be due to high rates of patients transferred in from other hospitals (42.9%), readmissions (12.7%), high rates of admissions due to infectious conditions (gynaecological and obstetric) in women (13.22%), admissions with coexisting TB (25.4%) and HIV (40.04% where known), high rates of catheterization (>50%) as well as malnourishment in a minority of patients (5%). The type of infections seen had similarities with the Global PPS where pneumonia or lower respiratory tract infections, skin and soft tissue infections, intra-abdominal and urinary tract infections were the most prevalent infections [46], with Kenya where gynecological sites, respiratory tract, skin, and soft tissue infections were among the most prevalent sites [35,39] and South Africa where bone and joint infections, gynecological sites, respiratory tract, as well as skin and soft tissue infections were among the most prevalent infections [40]. In Ghana, the wards with the highest prevalence of antibiotic use were pediatric surgery, child health, orthopedics and general surgery [52].…”

Section: Discussionmentioning

confidence: 78%

“…We are aware of the high and often inappropriate prescribing and dispensing of antibiotics in ambulatory care [1,[21][22][23][24][25]] driving up AMR rates. However, there is also high and inappropriate use of antibiotics in hospitals in both high income [26][27][28][29][30][31][32][33] as well as in low and middle income countries (LMICs), driven in some countries by high rates of sexually transmitted infections, HIV, TB and malaria among in-patients [34][35][36][37][38][39][40][41]. A key step to improving antimicrobial use in hospitals is to monitor current utilization patterns and instigate activities to improve this where pertinent via Drugs and Therapeutics Committees (DTCs) and antimicrobial stewardship programmes (ASPs) [11,35,39,[42][43][44][45][46].…”

Section: Introductionmentioning

confidence: 99%

“…This resulted in the data collection forms being amended prior to undertaking the full PPS study among hospitals in Botswana. The finalized data collection forms also formed the basis for similar PPS studies in other sub-Saharan African countries including South Africa and Zimbabwe [40,69,70].…”

Section: Introductionmentioning

confidence: 99%

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Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications

Paramadhas

Tiroyakgosi

Mpinda-Joseph

et al. 2019

Expert Review of Anti-infective Therapy

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Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications

Paramadhas

Tiroyakgosi

Mpinda-Joseph

et al. 2019

Expert Review of Anti-infective Therapy

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“…A high proportion of patients in our study received antibiotics before the availability of culture results, similar to other studies [53]. However, different to a recent study in South Africa where 83% of antibiotics were modi ed following sensitivity reports [54]. Consequently, prescribing behavior may be due to a desire to prevent patients getting severe infections without waiting for sensitivity reports.…”

Section: Discussionsupporting

confidence: 72%

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Altaf

Akhtar

Ahmad

et al. 2020

Preprint

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Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empirical therapy to be adjusted according to the result of culture sensitivity reports.Objective: To find the impact of culture sensitivity reports on the use of antibiotics and cost in a leading tertiary care hospital in Lahore.Methods: This prospective observational study was carried out in Ghurki trust teaching hospital. A total of 465 positive culture patients were taken over an 8 month study period using convenient sampling techniques and immediately sent to the microbiology laboratory for pathogen identification and susceptibility testing using the Kirby-Bauer disc diffusion method. Additional data was collected from the patient medical file which included demographic data, sample type, causative microbe, anti-microbial treatment given in empirical and definitive treatment as well as medicine costs. Results: Total of 497 isolates were detected from the 465 patient samples, which included 309 gram-negative rods and 188 gram-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was MSSA (28.4%) and Gram-negative was E. coli (23.8%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the A. baumannii isolates were resistant to carbapenems. Gram-positive microorganism showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics in empirical therapy were cefoperazone+sulbactam, ceftriaxone, amikacin, vancomycin and metronidazole whereas high use of linezolid, clindamycin, meropenem and piperacillin + tazobactam was evidenced in definitive treatment. Empiric therapy was adjusted in 222 (71.8%) cases of Gram-negative infections and 131 (69.6%) cases of gram-positive infections (p-value <0.0001). Compared with empirical therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average costs of antibiotics in definitive treatment was less than the empirical treatment (8.2%) and the length of hospitalization also decreased.Conclusion: Culture sensitivity reports helped reduce antibiotic utilization, hospital stay and costs as well as helping select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs and the development of hospital antibiotic guidelines within the hospital to reduce future unnecessary prescribing of broad-spectrum antibiotics.

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Status of antimicrobial stewardship programmes in Nigerian tertiary healthcare facilities: Findings and implications

Fadare

Ogunleye

Iliyasu

et al. 2019

Journal of Global Antimicrobial Resistance

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Objectives: The problem of antimicrobial resistance (AMR) is increasing worldwide with health-related and economic consequences. This is a concern in Africa, including Nigeria the most populous country in Africa, with its high rates of infectious diseases. Approaches to reducing AMR include instigating antimicrobial stewardship programs (ASPs) in hospitals. Currently, no information is available regarding the extent of ASPs in Nigerian hospitals. Consequently, the objective was to address this starting in tertiary hospitals. METHODS: Cross-sectional, questionnaire-based study among tertiary healthcare facilities. Tertiary hospitals were chosen initially since if there are concerns in these training hospitals, such concerns will likely to be exacerbated in others. RESULTS: Completed questionnaires were received from 17 out of 25 tertiary healthcare facilities across five of the six geo-political regions of Nigeria. 10 (58.8%), four (23.6%), two (11.8%) and one (5.8%) respondents were in internal medicine, infectious diseases, medical microbiology and clinical pharmacology respectively. Only six (35.3%) healthcare facilities had a formal organizational structure and a team responsible for ASP. Facility-specific treatment recommendations, based on local AMR patterns, were available in only four (23.5%) facilities. Policies on approval for prescribing specified antimicrobial agents and formal procedures for reviewing their appropriateness after 48 hours was present in only 2 (11.8%) facilities. The cumulative antimicrobial susceptibility report for the previous year was available in only three (17.6%) facilities and only one facility routinely monitored antimicrobial use. CONCLUSION: Significant inadequacies in the availability of ASPs programmes were seen. This needs to be urgently addressed to reduce AMR rates in Nigeria.

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Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: a pilot study and implications

Cited by 34 publications

References 43 publications

Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications

Point prevalence study of antimicrobial use among hospitals across Botswana; findings and implications

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Status of antimicrobial stewardship programmes in Nigerian tertiary healthcare facilities: Findings and implications

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