Opportunities for Improving Antimicrobial Stewardship

Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries

Bibliographic Data

ID22080643
AuthorsFlorida Muro (0000-0002-5127-3995, Kilimanjaro Christian Medical Centre, corresponding author), Florida J Muro, Furaha S Lyamuya (0000-0002-2319-8246, Kilimanjaro Christian Medical Centre), Charles Kwobah (Moi University), John Bollinger (Duke University), Champica K Bodinayake (0000-0003-1339-1883, University of Ruhuna), Ajith Nagahawatte (0000-0001-6481-0203, University of Ruhuna), Bhagya Piyasiri (Teaching Hospital Kandy), Ruvini Kurukulasooriya (0000-0002-9783-4313, University of Ruhuna), Shamim Ali (0000-0002-9329-9026, Moi University), Rose Mallya (Kilimanjaro Christian Medical Centre), Robert Rolfe (0000-0001-9181-4023, Duke University), Anushka Ruwanpathirana (0000-0003-2495-9489, The Ohio State University), Tianchen Sheng (Duke University), Truls Østbye (0000-0002-0662-7440, Duke University), Richard Drew, Richard H Drew (0000-0003-0406-0804, Campbell University), Peter S Kussin (0000-0002-4938-9809, Duke University), Peter Kussin, Christopher W Woods (0000-0001-7240-2453, Duke University), Deverick J Anderson (0000-0001-6882-5496, Duke University), Blandina T Mmbaga (0000-0002-5550-1916, Duke Institute for Health Innovation), L Gayani Tillekeratne (0000-0001-6012-7271, University of Ruhuna, corresponding author)
Year2022
Volume10
Pages848802-848802
Publication date2022-04-25
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2022.848802
PMID35548085
OpenAlexW4224315980
LanguageEN
Citations received2
References cited28

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

Antibiotic resistance · Antibiotics · Antimicrobial · Antimicrobial stewardship · Intensive care medicine · Lower respiratory tract infection · Respiratory tract infections · Tanzania · Antibiotic Use and Resistance · Bacterial Identification and Susceptibility Testing · Medicine · Nosocomial Infections in ICU · Emergency Medicine · Internal Medicine · Pediatrics

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