Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries.

Autor:	Muro FJ; Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.; Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.; Kilimanjaro Christian Research Institute, Moshi, Tanzania., Lyamuya FS; Kilimanjaro Christian Research Institute, Moshi, Tanzania.; Internal Medicine Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania., Kwobah C; Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya., Bollinger J; Duke-Margolis Center for Health Policy, Washington, DC, United States.; Duke Global Health Institute, Durham, NC, United States.; Duke University, Durham, NC, United States., Bodinayake CK; Duke Global Health Institute, Durham, NC, United States.; University of Ruhuna, Galle, Sri Lanka., Nagahawatte A; Duke Global Health Institute, Durham, NC, United States.; University of Ruhuna, Galle, Sri Lanka., Piyasiri B; Teaching Hospital Karapitiya, Galle, Sri Lanka., Kurukulasooriya R; University of Ruhuna, Galle, Sri Lanka., Ali S; Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya., Mallya R; Kilimanjaro Christian Research Institute, Moshi, Tanzania.; Reproductive and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania., Rolfe R Jr; Duke Global Health Institute, Durham, NC, United States.; Duke University, Durham, NC, United States., Ruwanpathirana A; Ohio State University, Columbus, OH, United States., Sheng T; Duke Global Health Institute, Durham, NC, United States.; Duke University, Durham, NC, United States., Østbye T; Duke Global Health Institute, Durham, NC, United States.; Duke University, Durham, NC, United States., Drew R; Duke University, Durham, NC, United States.; Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, United States., Kussin P; Duke University, Durham, NC, United States., Woods CW; Duke Global Health Institute, Durham, NC, United States.; Duke University, Durham, NC, United States., Anderson DJ; Duke University, Durham, NC, United States.; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, United States., Mmbaga BT; Kilimanjaro Christian Research Institute, Moshi, Tanzania.; Duke Global Health Institute, Durham, NC, United States.; Paediatric and Child Health Department, Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Moshi, Tanzania., Tillekeratne LG; Duke Global Health Institute, Durham, NC, United States.; Duke University, Durham, NC, United States.; University of Ruhuna, Galle, Sri Lanka.
Jazyk:	angličtina
Zdroj:	Frontiers in public health [Front Public Health] 2022 Apr 25; Vol. 10, pp. 848802. Date of Electronic Publication: 2022 Apr 25 (Print Publication: 2022).
DOI:	10.3389/fpubh.2022.848802
Abstrakt:	Background: To develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and patterns of antimicrobial use in three LMIC hospitals. Methods: Consecutive patients admitted to the adult medical wards in three tertiary care hospitals in Tanzania, Kenya, and Sri Lanka were enrolled in 2018-2019. The medical record was reviewed for clinical information including type and duration of antimicrobials prescribed, indications for antimicrobial use, and microbiologic testing ordered. Results: A total of 3,149 patients were enrolled during the study period: 1,103 from Tanzania, 750 from Kenya, and 1,296 from Sri Lanka. The majority of patients were male (1,783, 56.6% overall) with a median age of 55 years (IQR 38-68). Of enrolled patients, 1,573 (50.0%) received antimicrobials during their hospital stay: 35.4% in Tanzania, 56.5% in Kenya, and 58.6% in Sri Lanka. At each site, the most common indication for antimicrobial use was lower respiratory tract infection (LRTI; 40.2%). However, 61.0% received antimicrobials for LRTI in the absence of LRTI signs on chest radiography. Among patients receiving antimicrobials, tools to guide antimicrobial use were under-utilized: microbiologic cultures in 12.0% and microbiology consultation in 6.5%. Conclusion: Antimicrobials were used in a substantial proportion of patients at tertiary care hospitals across three LMIC sites. Future ASP efforts should include improving LRTI diagnosis and treatment, developing antibiograms to direct empiric antimicrobial use, and increasing use of microbiologic tests. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Muro, Lyamuya, Kwobah, Bollinger, Bodinayake, Nagahawatte, Piyasiri, Kurukulasooriya, Ali, Mallya, Rolfe, Ruwanpathirana, Sheng, Østbye, Drew, Kussin, Woods, Anderson, Mmbaga and Tillekeratne.)
Databáze:	MEDLINE
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