Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned

Alabi, Abraham; Picka, Stephen W; Sirleaf, Reubvera; Ntirenganya, Pacifique R; Ayebare, Arnold; Correa, Nidia; Anyango, Sarah; Ekwen, Gerald; Agu, Emmanuel; Cook, Rebecca J.; Yarngrorble, John; Sanoe, Ibrahim; Dugulu, Henry; Wiefue, Emmanuel; Gahn-Smith, Diana; Kateh, Francis; Hallie, Ezekiel Fayiah; Sidonie, Christiane G; Aboderin, AO; Vassellee, David; Bishop, Damien; Lohmann, Daniel; Naumann-Hustedt, Manja; Dörlemann, Alois; Schaumburg, Frieder

doi:10.1093/jacamr/dlac069

Cited by 14 publications

(7 citation statements)

References 27 publications

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“…% oral vs. IV antibiotics (including as part of de-escalation policies) [15,76,82,114,166,168,171,[178][179][180][181] % of missed doses documented in patients' notes, e.g., as part of a PPS [19,148] % of antibiotics prescribed by their international non-proprietary name, e.g., as part of a PPS [182,183] % compliance to agreed process measures surrounding AMS [184] % of patients prescribed antibiotics within the country's essential medicine list over an agreed period of time [61,171,180,182,183] Process quality indicators % of in-patients prescribed antibiotics in adherence to agreed guidelines within a specified time period/part of a PPS [81,112,134,168,[184][185][186][187][188][189][190][191] % of patients prescribed a course of antibiotics in accordance with guideline duration recommendations within a specified time period/ part of a PPS [166,176] % of patients where cultures are taken and sent for analysis to guide antibiotic prescribing/ targeted therapy within a specified time period/ part of a PPS [76,114,169,192] % of antibiotics prescribed based on the AWaRe classification/% reduction in the prescribing of target antibiotics, e.g., 'Watch' cephalosporins ...…”

Section: Indicator Referencesmentioning

confidence: 99%

“…However, there can be concerns instigating ASPs, with issues of resources, manpower, and knowledge among key stakeholders especially among low- and middle-income countries (LMICs) including African countries ( Box S1—Supplementary Material ) [ 128 , 129 , 130 , 131 ]. This though is also starting to change among African countries as well as among other LMICs [ 111 , 132 , 133 , 134 , 135 , 136 , 137 ]. We are likely to see more ASPs being instigated across Africa and beyond as part of NAPs to reduce AMR, enhanced by the availability of toolkits from the WHO and others [ 67 , 70 , 132 , 137 , 138 , 139 , 140 ].…”

Section: Introductionmentioning

confidence: 99%

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Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

et al. 2022

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There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.

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Section: Indicator Referencesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

et al. 2022

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“…Table S2—Examples of ASPs successively introduced across Africa to improve antimicrobial prescribing. This includes [ 95 , 96 , 97 , 98 ].…”

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confidence: 99%

Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

et al. 2022

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Introduction: There are increasing concerns with growing rates of antimicrobial resistance (AMR) across Africa, including in Zambia, enhanced by inappropriate utilization of antibiotics across the sectors. There is a need in hospitals to document current prescribing patterns via point prevalence surveys (PPS) alongside recognized indicators to improve future use. The findings can subsequently be used to develop and instigate appropriate antimicrobial stewardship programs (ASPs) to improve the quality of future antimicrobial prescribing across Zambia. This includes encouraging the prescribing of ‘Access’ over ‘Watch’ and ‘Reserve’ antibiotics where pertinent. Methods: A PPS was undertaken using the WHO methodology among 10 first- and second-level public hospitals across the 10 provinces of Zambia. A sampling process was used to select the hospitals. Results: The prevalence of antibiotic use among the in-patients was 307/520 (59.0%), with a high rate of empiric prescribing of ceftriaxone at 36.1% of all antibiotics prescribed (193/534). The reason for antibiotic use was recorded in only 15.7% of occasions and directed treatment prescribed in only 3.0% of occasions. Compliance with the national standard treatment guidelines (STGs) was also low at only 27.0% of occasions. Conclusion: High empiric prescribing, limited documentation of the rationale behind antibiotic prescribing, high use of ‘Watch’ antibiotics, and limited compliance to STGs among surveyed hospitals requires the urgent instigation of ASPs across Zambia to improve future prescribing.

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“… Lack of awareness amongst hospital management of the overall potential for cost-savings associated with such a policy change. Alabi (2022), 54 Liberia Implementation of a bundle of three measures (local treatment guideline, training and regular ASP ward rounds) to guide antibiotic use 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 79.7% of patients had samples sent for microbiological analysis. Proportion of patients receiving ceftriaxone significantly reduced after the ASP ward rounds from 51.3% to 14.2% (p < 0.0005) In addition to changing prescribing behavior, ASPs face the challenge of underfunding and limited access to experts, expertise and training.…”

Section: Resultsmentioning

confidence: 99%

“…Alabi (2022), 54 Liberia Implementation of a bundle of three measures (local treatment guideline, training and regular ASP ward rounds) to guide antibiotic use • In addition to changing prescribing behavior, ASPs face the challenge of underfunding and limited access to experts, expertise and training.…”

Section: Kenyamentioning

confidence: 99%

Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications

Siachalinga¹,

Godman²,

Mwita³

et al. 2023

IDR

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Background The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with the data obtained from point prevalence surveys (PPS), hence the need to document antibiotic utilization patterns in sub-Saharan Africa. Methods A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. Results Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. Conclusion Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.

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Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned

Cited by 14 publications

References 27 publications

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future

Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications

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