'Prospective audit with intervention and feedback' as a core antimicrobial stewardship strategy in the paediatrics department of a Nigerian tertiary hospital.

Autor:	Ola-Bello OI; Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria., Akintan PE; College of Medicine, University of Lagos, Idi-Araba Lagos; Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria., Osuagwu CS; Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital; College of Medicine, University of Lagos, Idi-Araba Lagos, Nigeria., Oshun PO; Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital; College of Medicine, University of Lagos, Idi-Araba Lagos, Nigeria., Fajolu IB; College of Medicine, University of Lagos, Idi-Araba Lagos; Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria., Nwaiwu O; Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria., Olusanya A; Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria., Busari AA; Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Lagos, Nigeria., Roberts AA; College of Medicine, University of Lagos, Idi-Araba; Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos, Nigeria., Temiye EO; College of Medicine, University of Lagos, Idi-Araba Lagos; Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria., Omotayo O; College of Medicine, University of Lagos, Idi-Araba Lagos, Nigeria., Oduyebo OO; Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital; College of Medicine, University of Lagos, Idi-Araba Lagos, Nigeria.
Jazyk:	angličtina
Zdroj:	The Nigerian postgraduate medical journal [Niger Postgrad Med J] 2023 Apr-Jun; Vol. 30 (2), pp. 137-143.
DOI:	10.4103/npmj.npmj_257_22
Abstrakt:	Introduction: Inappropriate use of antibiotics for childhood illnesses, especially for non-bacterial infections, contributes to the development of antimicrobial resistance (AMR). Globally, implementation of antimicrobial stewardship programme (ASP) in all healthcare institutions is a strategic intervention to improve the appropriate use of antibiotics, reduce antimicrobial consumption and tackle AMR. The aim of this study was to evaluate the effect of prospective audit with intervention and feedback as an antimicrobial stewardship strategy on antimicrobial use, evaluate prescribers' response to recommendations and determine the rate of AMR in the Paediatrics Department of the Lagos University Teaching Hospital, Nigeria. Materials and Methods: This was an implementation study of the paediatrics Antimicrobial Stewardship Programme (ASP) over a period of 6 months. It was initiated with a point prevalence survey (PPS) to describe the antimicrobial prescribing patterns and followed by prospective audit with interventions and feedback using an antimicrobial checklist and the existing antimicrobial guidelines in the Paediatrics Department. Results: The antibiotic prescribing prevalence was high (79.9%) at baseline PPS with 139 patients on admission, of which 111 (79.9%) were treated with 202 antibiotic therapies. Over the 6 months of study, 582 patients on 1146 antimicrobial therapies were audited. Compliance with departmental guidelines was 58.1% of the total 1146 prescriptions audited (n = 666), making the antimicrobial prescription inappropriate in 41.9% (n = 480) of therapies. The most recommended intervention for inappropriateness was 'change antibiotics' 48.8% (n = 234), followed by 'stop antibiotics' 26% (n = 125), 'reduce the number of antibiotics' 19.6% (n = 194) and 'de-escalate' 2.4% (n = 11). Agreement with ASP interventions occurred in 193 (40.2%) cases, and the least agreed intervention was 'stop antibiotics' (n = 40, 32%). However, there was a steady increase in compliance rates with ASP interventions over the 6 months of period study, which was statically significant (χ 2: 30.005; P = 0.001). Conclusion: ASP prospective audit with intervention and feedback was of significant benefit in improving compliance with antimicrobial guidelines, thereby improving antimicrobial therapy in the Paediatrics Department of LUTH, Nigeria.
Databáze:	MEDLINE
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