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Moore DP, Chetty T, Pillay A, Karsas M, Cloete J, Balakrishna Y, Reddy T, Archary M, van Kwawegen A, Thomas R, Nakwa FL, Waggie Z, Magrath S, Goga A, Jeena P. Antibiotic and antifungal use in paediatric departments at three academic hospitals in South Africa. IJID REGIONS 2024; 10:151-158. [PMID: 38314394 PMCID: PMC10835277 DOI: 10.1016/j.ijregi.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 02/06/2024]
Abstract
Objectives South Africa implemented a National Strategic Framework to optimise antimicrobial stewardship in 2014; however, there is limited data on how this has affected prescribing, especially to children treated in academic centres. Methods We conducted a point prevalence survey using the World Health Organization (WHO) methodology to evaluate antibiotic and antifungal prescribing practices in paediatric departments at three academic hospitals in South Africa. Results We recorded 1946 antimicrobial prescriptions in 1191 children, with 55.2% and 39.2% of the antibiotics classified as WHO AWaRe Access and Watch drugs, respectively. There were significant differences in prescription of Reserve antibiotics and antifungals between institutions. Receipt of WHO Watch and Reserve antibiotics was independently associated with infancy (<12 months) and adolescents (13-17 years) (adjusted relative risk [aRR]: 2.09-9.95); prolonged hospitalisation (aRR: 3.29-30.08); rapidly or ultimately fatal illness (aRR: 1.94 to 5.52); and blood transfusion (aRR: 3.28-5.70). Antifungal prescribing was associated with treatment of hospital-associated infection (aRR: 2.90), medical prophylaxis (aRR: 3.30), and treatment in intensive care units (aRR: 2.15-2.27). Conclusions Guidance on optimisation of infection prevention and control practice and strengthening of antimicrobial stewardship would impact positively on the care of sick children in our setting.
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Affiliation(s)
- David P. Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Terusha Chetty
- HIV And Other Infectious Diseases Unit, South African Medical Research Council & Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Maria Karsas
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Jeané Cloete
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Alison van Kwawegen
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose L. Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Zainab Waggie
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Magrath
- Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa
| | - Ameena Goga
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Prakash Jeena
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
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Chetty T, Pillay A, Balakrishna Y, Reddy T, Goga A, Moore DP, Karsas M, Cloete J, Archary M, Kwawegen AV, Thomas R, Nakwa FL, Waggie Z, Magrath S, Jeena P. Healthcare-Associated Infections Drive Antimicrobial Prescribing in Pediatric Departments at Three Academic Hospitals in South Africa. Pediatr Infect Dis J 2023; Publish Ahead of Print:00006454-990000000-00494. [PMID: 37368998 DOI: 10.1097/inf.0000000000003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The prevalence of antimicrobial prescriptions for healthcare-associated infections (HAI) in South Africa is largely unknown. This study aimed to estimate the point prevalence of pediatric antibiotic and antifungal usage in 3 South African academic hospitals. METHODS This cross-sectional study included hospitalized neonates and children (0-15 years). We used the World Health Organization methodology for antimicrobial point prevalence studies, with weekly surveys to achieve a sample size of ~400 at each site. RESULTS Overall, 1,946 antimicrobials were prescribed to 1,191 patients. At least 1 antimicrobial was prescribed for 22.9% [95% confidence interval (CI): 15.5-32.5%] of patients. The prevalence of antimicrobial prescribing for HAI was 45.6%. In the multivariable analysis, relative to children 6-12 years, neonates [adjusted relative risk (aRR): 1.64; 95% CI: 1.06-2.53], infants (aRR: 1.57; 95% CI: 1.12-2.21) and adolescents (aRR: 2.18; 95% CI: 1.45-3.29) had significantly increased risk of prescriptions for HAI. Being preterm (aRR: 1.33; 95% CI: 1.04-1.70) and underweight (aRR: 1.25; 95% CI: 1.01-1.54) was predictive of antimicrobial usage for HAI. Having an indwelling device, surgery since admission, blood transfusions and classification as rapidly fatal on McCabe score also increased the risk of prescriptions for HAI. CONCLUSIONS The high prevalence of antimicrobial prescribing for HAI to treat children with recognized risk factors in academic hospitals in South Africa is concerning. Concerted efforts need to be made to strengthen hospital-level infection prevention and control measures, with a critical review of antimicrobial usage through functional antibiotic stewardship programs to preserve the available antimicrobial armamentarium at the hospital level.
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Affiliation(s)
- Terusha Chetty
- From the HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, South Africa
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Ameena Goga
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - David P Moore
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccine and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Karsas
- Department of Pediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Jeané Cloete
- Maternal and Infant Health Care Strategies Research Unit Centre, University of Pretoria, Pretoria, South Africa
| | - Moherndran Archary
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alison van Kwawegen
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose Lambey Nakwa
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Zainab Waggie
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Magrath
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and
| | - Prakash Jeena
- Department of Pediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Pediatrics and Child Health, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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3
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Rudnick W, Conly J, Thirion DJG, Choi K, Pelude L, Cayen J, Bautista J, Beique L, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, Happe J, Katz K, Kibsey P, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, McKenna S, Neville HL, Slayter K, Suh KN, Tse-Chang A, Weiss K, Science M. Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018. Antimicrob Resist Infect Control 2023; 12:35. [PMID: 37072874 PMCID: PMC10111695 DOI: 10.1186/s13756-023-01219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Antimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals. METHODS Acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd). RESULTS Nine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409-554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd). CONCLUSIONS This study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.
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Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Conly
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Foothills Medical Centre, Alberta Health Services, 3330 Hospital Dr. NW, Calgary, AB, T2N 2T9, Canada
| | - Daniel J G Thirion
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Kelly Choi
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Linda Pelude
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Joelle Cayen
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Bautista
- Central Newfoundland Regional Health Centre, 50 Union, Grand Falls-Windsor, NL, A2A 2E1, Canada
| | - Lizanne Beique
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | | | - Bruce Dalton
- Alberta Health Services, 1620 29 St NW, Calgary, AB, T2N 4L7, Canada
| | - Johan Delport
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Rita Dhami
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Joanne Embree
- University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Shared Health Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Children's Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB, R3E 0Z3, Canada
| | - Yannick Émond
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Gerald Evans
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Charles Frenette
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Susan Fryters
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Jennifer Happe
- Infection Prevention and Control Canada, Red Deer, AB, T4N 6R2, Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, North York, ON, M2K 1E1, Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada
| | - Joanne M Langley
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
- Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada
| | - Bonita E Lee
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Marie-Astrid Lefebvre
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jerome A Leis
- Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Allison McGeer
- Sinai Health System, 600 University Ave, Toronto, ON, M5G 1X5, Canada
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Susan McKenna
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Heather L Neville
- Nova Scotia Health, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Kathryn Slayter
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Kathryn N Suh
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Alena Tse-Chang
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Karl Weiss
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
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Umeokonkwo CD, Onah CK, Adeke AS, Igwe-Okomiso DO, Umeokonkwo AA, Madubueze UC, Dauda SO, Okeke KC, Versporten A, Oduyebo OO, Goossens H, Agu AP. Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey. J Infect Prev 2023; 24:71-76. [PMID: 36815059 PMCID: PMC9940237 DOI: 10.1177/17571774231152719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Aim Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. Subject and Method The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Result Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Conclusion Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.
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Affiliation(s)
- Chukwuma D Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Cosmas K Onah
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Azuka S Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Dorothy O Igwe-Okomiso
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Adanna A Umeokonkwo
- Department of Paediatric, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugochukwu C Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Saheed O Dauda
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Kingsley C Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Oyinlola O Oduyebo
- Department of Microbiology, Lagos University Teaching Hospital, Surulere, Nigeria
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Adaoha P Agu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
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5
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Spatiotemporal Investigation of Antibiotic Resistance in the Urban Water Cycle Influenced by Environmental and Anthropogenic Activity. Microbiol Spectr 2022; 10:e0247322. [PMID: 36036576 PMCID: PMC9603458 DOI: 10.1128/spectrum.02473-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
With increasing emergence of antimicrobial resistant bacteria (ARB) and the risk this poses to public health, there are growing concerns regarding water pollution contributing to the spread of antimicrobial resistance (AMR) through inadequate amenities and the rapid rate of urbanization. In this study, the impact of different anthropogenic factors on the prevalence of AMR in the urban water cycle in Stellenbosch, South Africa (SA) was examined. Carbapenem, colistin, gentamicin and sulfamethoxazole resistant Gram-negative bacteria were recovered by selectively culturing aqueous, biofilm and sediment samples from sites impacted to varying degrees by informal settlements, residential, industrial, and agricultural activities, as well as a municipal wastewater treatment works (WWTW). A metagenomic approach determined community profiles and dominant AMR genes at various sites, while carbapenem resistant colonies were characterized using whole genome sequencing (WGS). Isolates recovered from agricultural sites exhibited relatively high levels of resistance to carbapenems and colistin, whereas sites impacted by domestic run-off had a higher prevalence of resistance to gentamicin and sulfamethoxazole, corresponding to usage data in SA. Similar microbial taxa were identified in raw sewage, sites downstream of informal settlements, and industrial areas that have limited waste removal infrastructure while WWTW were seen to reduce the prevalence of ARB in treated wastewater when operating efficiently. The results indicate the multiple complex drivers underpinning environmental dissemination of AMR and suggest that WWTW assist in removing AMR from the environment, reinforcing the necessity of adequate waste removal infrastructure and antibiotic stewardship measures to mitigate AMR transmission. IMPORTANCE The results from this study are of importance as they fill a gap in the data available on environmental AMR in South Africa to date. This study was done in parallel with co-investigators focusing on the prevalence of various antimicrobials at the same sites selected in our study, verifying that the sites that are influenced by informal settlements and WWTW influent had higher concentrations of antimicrobials and antimicrobial metabolites. The various locations of the sample sites selected, the frequency of the samples collected over a year, and the different types of samples collected at each site all contribute to informing how AMR in the environment might be affected by anthropogenic activity.
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6
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Godman B, Egwuenu A, Wesangula E, Schellack N, Kalungia AC, Tiroyakgosi C, Kgatlwane J, Mwita JC, Patrick O, Niba LL, Amu AA, Oguntade RT, Alabi ME, Ncube NBQ, Sefah IA, Acolatse J, Incoom R, Guantai AN, Oluka M, Opanga S, Chikowe I, Khuluza F, Chiumia FK, Jana CE, Kalemeera F, Hango E, Fadare J, Ogunleye OO, Ebruke BE, Meyer JC, Massele A, Malande OO, Kibuule D, Kapona O, Zaranyika T, Bwakura-Dangarembizi M, Kujinga T, Saleem Z, Kurdi A, Shahwan M, Jairoun AA, Wale J, Brink AJ. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert Opin Drug Saf 2022; 21:1089-1111. [PMID: 35876080 DOI: 10.1080/14740338.2022.2106368] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. AREAS COVERED Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. EXPERT OPINION All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Abiodun Egwuenu
- AMR Programme, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Evelyn Wesangula
- Patient and Health Workers Safety Division, AMR Focal Point, Ministry of Health, Nairobi, Kenya
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone, Botswana
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Israel Abebrese Sefah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis K Chiumia
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Collins Edward Jana
- Division of Biochemistry, Biomedical Sciences Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Abuja, Nigeria
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Tororo, Uganda
| | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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7
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Kitt E, Hayes M, Ballester L, Sewawa KB, Mulale U, Mazhani L, Arscott-Mills T, Coffin SE, Steenhoff AP. Assessing antibiotic utilization among pediatric patients in Gaborone, Botswana. SAGE Open Med 2022; 10:20503121221104437. [PMID: 36814934 PMCID: PMC9939905 DOI: 10.1177/20503121221104437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Over the past decade, concerning trends in antimicrobial resistance have emerged in Southern Africa. Given a paucity of pediatric data, our objectives were to (1) describe antibiotic utilization trends at a national referral center in Southern Africa and (2) assess the proportion of patients receiving antibiotics appropriately. In addition, risk factors for inappropriate use were explored. Methods We performed a prospective cohort study on medical and surgical pediatric patients aged below 13 years admitted to the country's tertiary care referral hospital in Gaborone, Botswana. We collected demographics, clinical, laboratory, and microbiology details, in addition to information on antibiotic use. We separately categorized antibiotic prescriptions using the World Health Organization AWaRe Classification of Access, Watch, and Restrict. Results Our final cohort of 299 patients was 44% female and 27% HIV-exposed; most (68%) were admitted to the General Pediatrics ward. Infections were a common cause of hospitalization in 29% of the cohort. Almost half of our cohort were prescribed at least one antibiotic during their stay, including 40% on admission; almost half (47%) of these prescriptions were deemed appropriate. At the time of discharge, 52 (21%) patients were prescribed an antibiotic, of which 37% were appropriate. Of all antibiotics prescribed, 42% were from the World Health Organization Access antibiotic list, 58% were from the Watch antibiotic list, and 0% were prescribed antibiotics from the Restrict antibiotic list. Univariate analyses revealed that surgical patients were significantly more likely to have inappropriate antibiotics prescribed on admission. Patients who were treated for diseases for which there was a clinical pathway, or who had blood cultures sent at the time of admission were less likely to have inappropriate antibiotics prescribed. On multivariate analysis, apart from admission to the surgical unit, there were no independent predictors for inappropriate antibiotic use, although there was a trend for critically ill patients to receive inappropriate antibiotics. Conclusion Our study reveals high rates of antibiotic consumption, much of which was inappropriate. Promising areas for antimicrobial stewardship interventions include (1) standardization of management approaches in the pediatric surgical population and (2) the implementation of feasible and generalizable clinical pathways in this tertiary care facility.
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Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases,
Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Infection Prevention and
Control, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Eimear Kitt, The Hub for Clinical
Collaboration, Division of Infectious Diseases, Floor 9 Room 9549, 3500 Civic
Center Blvd, Philadelphia, PA 19104, USA.
| | - Molly Hayes
- Antimicrobial Stewardship Program,
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lance Ballester
- Biostatistics and Data Management Core,
Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Unami Mulale
- Department of Paediatrics and
Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone,
Botswana
| | - Loeto Mazhani
- Department of Paediatrics and
Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone,
Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Botswana-UPenn Partnership, Gaborone,
Botswana,Department of Paediatrics and
Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone,
Botswana
| | - Susan E Coffin
- Division of Infectious Diseases,
Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Department of Infection Prevention and
Control, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew P Steenhoff
- Division of Infectious Diseases,
Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Pediatrics, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Botswana-UPenn Partnership, Gaborone,
Botswana,Department of Paediatrics and
Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone,
Botswana
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8
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Skosana PP, Schellack N, Godman B, Kurdi A, Bennie M, Kruger D, Meyer JC. A national, multicentre web-based point prevalence survey of antimicrobial use and quality indices among hospitalised paediatric patients across South Africa. J Glob Antimicrob Resist 2021; 29:542-550. [PMID: 34915203 DOI: 10.1016/j.jgar.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Data on antimicrobial consumption among the paediatric population in public hospitals in South Africa is limited. These needs to be addressed to improve future use and reduce antimicrobial resistance rates. Consequently, the objective is to quantify antimicrobial usage;and identify and classify which antimicrobials are used in the peadiatric population in public sector hospitals in South Africa according to World Health Organiosation (WHO) AWaRe list of antimicrobials METHODS: Conduct a point prevalence survey among 18 public sector hospitals from nine provinces using a newly developed web-based application. The data will be analysed according to the WHO AwaRe list to guide future quality improvement programmes. RESULTS 1261 paediatric patient files were reviewed with 49.7% (627/1261) receiving at least one antimicrobial, with 1013 antimicrobials prescribed overall. The top five antimicrobials included ampicillin (16.4%), gentamycin (10.0%), amoxicillin and enzyme inhibitor (9.6%), ceftriaxone (7.4%), and amikacin (6.3%). Antimicrobials from the Access classification were the most used (55.9%) with 3.1% being from the Reserve classification. The most common infectious conditions were pneumonia (21.3%; 148/1013) and clinical sepsis (16.0%; 111/1013). Parenteral administration (75.6%) and prolonged surgical prophylaxis (66.7%; 10/15) were common and concerns. 28% of the paediatric patients had cultures requested for them before antimicrobial treatment (284/1013) however only 38.7% (110/284) of culture results were available in the files. CONCLUSION Overall, antimicrobial prescribing is common among paediatric patients in South Africa. Interventions should be targeted at improving antimicrobial prescribing, including surgical prophylaxis, and encouraging greater use of oral antibiotics.
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Affiliation(s)
- P P Skosana
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa.
| | - N Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa.
| | - B Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.
| | - A Kurdi
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates.
| | - M Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
| | - D Kruger
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa
| | - J C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Gauteng, South Africa; Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.
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9
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Mustafa ZU, Salman M, Yasir M, Godman B, Majeed HA, Kanwal M, Iqbal M, Riaz MB, Hayat K, Hasan SS. Antibiotic consumption among hospitalized neonates and children in Punjab province, Pakistan. Expert Rev Anti Infect Ther 2021; 20:931-939. [PMID: 34591720 DOI: 10.1080/14787210.2021.1986388] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Periodic surveillance of antibiotic consumption in the form of point prevalence studies is a quick and robust methodology to evaluate prescribing trends in hospitals. The current study was undertaken to document antibiotic consumption among neonates and children from hospitals in Pakistan. METHODS This large multicenter study using the World Health Organization standardized methodology and AWaRe (Access, Watch, and Reserve) classification examined antibiotic consumption for suspected bacterial infection among neonates and children admitted hospitals in Punjab, Pakistan. RESULTS A total of 708 beds of children wards of the 16 health facilities were examined. Almost all (97%) hospitalized children were prescribed antibiotics on the day of the assessment with 2.6 antibiotics per patient. The three most common indications were respiratory tract infections (31.58%), sepsis (26.52%), and prophylaxis for medical problems (10.30%). The three most frequently prescribed antibiotics were ceftriaxone (24.2%), amikacin (23.2%), and ampicillin (16.7%). Almost half of the antibiotics were prescribed from the 'Access' (49.5%) and 'Watch' (45.5%) categories under the AWaRe classification. However, no antimicrobial was prescribed from the 'Reserved' category. CONCLUSIONS Our findings indicate that empirical antimicrobials use among hospitalized children is highly prevalent in Pakistan. The utilization of 'Watch' category of antimicrobials is frequent, stressing immediate action.
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Affiliation(s)
- Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital, Pakpattan, Pakistan
| | - Muhammad Salman
- Department of Pharmacy, The University of the Lahore, Lahore, Pakistan
| | - Muhammad Yasir
- Department of Medicine, Quaid E Azam Medical College Bahawalpur, Bahawalpur, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hafiz Abdul Majeed
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital, Pakpattan, Pakistan
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Okara South City, Okara, Pakistan
| | - Maryam Iqbal
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Hafiz Abad, Hafiz Abad, Pakistan
| | - Muhammad Bilal Riaz
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Chakwal, Chakwal, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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10
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Boone K, Morris SK, Doshi S, Black J, Mohsin M, Ahmed T, Al Mahmud A, Roth DE. Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh. J Trop Pediatr 2021; 67:5998440. [PMID: 33221898 PMCID: PMC8319631 DOI: 10.1093/tropej/fmaa093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Empirical antimicrobial use is common in hospitalized infants and may contribute to antimicrobial resistance in low- and middle-income countries. In this observational birth cohort study nested in a randomized controlled trial in Dhaka, Bangladesh, inpatient antimicrobial prescription data were extracted from serious adverse event forms completed for hospitalizations of infants (0-12 months of age). The primary outcome was the proportion of inpatient admissions where systemic antimicrobials were prescribed. Infant and hospitalization-related factors associated with antimicrobial prescriptions were determined. Among 1254 infants, there were 448 admissions to 32 facilities from 2014 to 2016. Antimicrobials were prescribed in 73% of admissions with a mean antimicrobial exposure rate of 0.25 antimicrobials per day of admission [95% confidence intervals (95% CIs): 0.24-0.27]. The most common antibiotics were aminoglycosides (29%), penicillins (26%) and third-generation cephalosporins (25%). In all, 58% of antibiotics were classified as 'access', 38% 'watch' and 1% 'reserve' using the World Health Organization (WHO) Essential Medicines List classification. WHO-recommended antimicrobial regimens were used in 68% of neonatal sepsis and 9% of lower respiratory tract infection (LRTI) admissions. 'Watch' antimicrobials were used in 26% of neonatal sepsis and 76% of LRTI admissions. Compared with private facilities, antimicrobial prescription rates were lower at government [rate ratio (RR) 0.71; 95% CI: 0.61-0.83] and charitable facilities (RR 0.39; 95% CI: 0.28-0.53), after adjustment for household wealth index and parental education. Younger infant age, older maternal age and longer admission were associated with higher prescription rates. These findings highlight the need for paediatric antimicrobial stewardship programs in Bangladesh.
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Affiliation(s)
- Katherine Boone
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON M5G 1X8, Canada.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Shaun K Morris
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON M5G 1X8, Canada.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Sejal Doshi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Jason Black
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Minhazul Mohsin
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Daniel E Roth
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON M5G 1X8, Canada.,Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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11
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Abdel-Qader DH, Ismael NS, Albassam A, El-Shara’ AA, Aljamal MS, Ismail R, Abdel-Qader HA, Hamadi S, Al Mazrouei N, Ibrahim OM. Antibiotics use and appropriateness in two Jordanian children hospitals: a point prevalence study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Although inappropriate antibiotics prescribing in hospitals is a key factor in accelerating antibiotic resistance, inadequate data are available about antibiotics prescribing rate and appropriateness. Our study aimed to measure antibiotics prescribing rate, indications, appropriateness and predictors.
Methods
The study was conducted in two public children hospitals (five wards) in Jordan using one-week point prevalence survey to prospectively collect the data. Appropriateness of antibiotics therapy was assessed by a multidisciplinary committee and predictors of inappropriate prescribing were studied through multivariate logistic regression.
Key findings
The overall antibiotics prescribing rate was 75.6% (n = 501/663), where the highest rate of antibiotics prescribing was in the Pediatrics ward (82.2%, n = 222/270). However, the lowest rate was in the Pediatric Intensive Care Unit (30.0%, 9/30). The most common antibiotics classes prescribed were: Beta-lactams (57.5%, n = 492/855). The most common underlying condition for antibiotics prescribing was upper respiratory tract infections (25.5%, n = 128/501) followed by pneumonia (20.6%, n = 103/501). Around half of antibiotics were prescribed upon appropriate decision (49.5%, n = 423/855). However, 22.0% (n = 188/855) of antibiotics were wrongly chosen, and 9.5% (n = 81/855) were wrongly applied. Initially inappropriate decision for prescription occurred in 15.3% (n = 131/855) of antibiotics. Ceftriaxone (OR 3.1; 95% CI 2.6–4.1; P = 0.03) and patients with ≥3 medication orders (OR 2.6; 95% CI 1.7–3.5; P = 0.001) significantly predicted inappropriate antibiotics prescribing.
Conclusions
The incidence of antibiotics prescribing in Jordanian children hospitals was high compared to other countries. Further multi-centric studies are required to enhance the generalisability of results and better develop effective and efficient antibiotic stewardship programmes.
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Affiliation(s)
| | | | - Abdullah Albassam
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait, Kuwait
| | | | | | - Rami Ismail
- Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Hasan A Abdel-Qader
- Consultant Pediatrician and Neonatologist, Ministry of Health, Amman, Jordan
| | - Salim Hamadi
- Faculty of Pharmacy & Medical Sciences, University of Petra, Amman, Jordan
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah., Sharjah, UAE
| | - Osama Mohamed Ibrahim
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah., Sharjah, UAE
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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12
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Olaru ID, Meierkord A, Godman B, Ngwenya C, Fitzgerald F, Dondo V, Ferrand R, Kranzer K. Assessment of antimicrobial use and prescribing practices among pediatric inpatients in Zimbabwe. J Chemother 2020; 32:456-459. [PMID: 32114964 PMCID: PMC7614934 DOI: 10.1080/1120009x.2020.1734719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
This study aims to assess antimicrobial consumption in the pediatric department of a tertiary care public hospital in Zimbabwe. Clinical records of pediatric inpatients admitted to Harare Central Hospital over a 3-week period were reviewed prospectively. Antimicrobial consumption was described as days of therapy per 100 inpatient days (DOT/100 PD). Adherence of antimicrobial drug prescriptions to the National Guidelines was also evaluated. A total of 121 (93.1%) children were prescribed at least one antimicrobial out of 130 children admitted. The median age was 14 months (IQR: 3 - 48 months). Overall antimicrobial consumption was 155.4 DOT/100 PD (95% CI 146-165.2). The most frequently prescribed antimicrobials were benzylpenicillin, gentamicin and ceftriaxone. Prescriptions were adherent to national guidelines in 57.7% of children. This study shows that there is high antimicrobial drug usage in hospitalized children in Zimbabwe and a considerable proportion of prescriptions are non-adherent with national guidelines.
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Affiliation(s)
- Ioana D. Olaru
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Anne Meierkord
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa, Pretoria, Gauteng, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, C168, Stockholm, Sweden
| | - Crispen Ngwenya
- Midlands State University, Faculty of Medicine, Department of Paediatrics, Senga Road, Gweru, Zimbabwe
| | - Felicity Fitzgerald
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Vogai Dondo
- Harare Central Hospital, Department of Pediatrics P. Box ST 14 Southerton, Harare, Zimbabwe
| | - Rashida Ferrand
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
- Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
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13
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Memon UA, Ahmed AR, Khalid M, Qadir K, Jabbar N, Junejo S, Haque AU. Clinical profile and outcome of carbapenem-resistant gram negative bacteremia in children with cancer in pediatric intensive care unit of a resource-limited country. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2020. [DOI: 10.1016/j.phoj.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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14
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Adegoke AA, Madu CE, Aiyegoro OA, Stenström TA, Okoh AI. Antibiogram and beta-lactamase genes among cefotaxime resistant E. coli from wastewater treatment plant. Antimicrob Resist Infect Control 2020; 9:46. [PMID: 32164766 PMCID: PMC7068970 DOI: 10.1186/s13756-020-0702-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 02/13/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) recently classified Enterobacteriaceae resistance to third-generation cephalosporin into the group of pathogens with critical criteria for future research. METHODS A study to assess the antibiogram and beta-lactamase genes among the cefotaxime resistant E. coli (CREc) from a South African wastewater treatment plant (WWTP) was conducted using standard phenotypic and molecular biology characterization methods. RESULTS Approximate total E. coli (TEc) concentration (log10 CFU/mL) ranged between 5.7 and 6.8 among which cefotaxime resistant E. coli were between 1.8 and 4.8 (log10 CFU/mL) for cefotaxime antibiotic concentration of 4 and 8 mg/L in the influent samples. Effluent samples, heavily influenced by the chlorination had only 0.3 log10 CFU/mL of TEc. Fifty-one cefotaxime resistant isolates were selected out of an overall of 75 isolates, and subjected to a new round of testing, with a follow up of 36 and 48 isolates for both colistin and gentamicin, respectively as guided by initial results. Selected CREc exhibited resistance to amoxicillin-clavulanic acid (35.3%; n = 51), colistin sulphate (76.5%; n = 36), ciprofloxacin (47.1%; n = 51), gentamicin (87.5%; n = 48) and intermediate-resistance to meropenem (11.8%; n = 51). Extended spectrum-beta-lactamase genes detected, viz.: blaCTX-M (52.6%; n = 38) and blaTEM (84.2%; n = 38) and concurrent blaCTX-M + blaTEM (36.8%; n = 38), but no blaSHV was detected. Carbapenem resistance genes, blaKPC-2 (15.8%; n = 38), blaOXA-1 (57.9%; n = 38), blaNDM-1 (15.8%; n = 38) were also detected. Approximately, 10.5 - 36.8% (n = 38) co-occurrence of two or more beta-lactamase genes was detected in some isolates. Out of the selected number (n = 30), 7(23.3%) were enterotoxigenic E. coli (ETEC), 14 (46.7%) were Enteroaggregative E. coli (EAEC), but no enteropathogenic E. coli (EPEC) was detected. CONCLUSION Resistance to cefotaxime and the presence of a wide range of beta-lactamase genes exposed the potential risks associated with these pathogens via occupational and domestic exposure during the reuse of treated wastewater.
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Affiliation(s)
- Anthony Ayodeji Adegoke
- SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, 4000, South Africa. .,Department of Microbiology, Faculty of Science, University of Uyo, PMB 1018, Uyo, Akwa Ibom State, Nigeria. .,Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa.
| | - Chibuzor Ezinne Madu
- SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, 4000, South Africa
| | - Olayinka Ayobami Aiyegoro
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa.,GI Microbiology and Biotechnology Unit, Agricultural Research Council- Animal Production, Irene, 0062, South Africa
| | - Thor Axel Stenström
- SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban, 4000, South Africa
| | - Anthony Ifeanyi Okoh
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa.,SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, South Africa
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15
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Araujo da Silva AR, Jaszkowski E, Schober T, von Both U, Meyer-Buehn M, Marques AF, Farkas B, de Abreu BS, di Biase CB, Takahashi JM, de Castro LD, Leal IA, Teixeira CH, Nussbaum CF, Hoffmann F, Hübner J. Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil. Eur J Clin Microbiol Infect Dis 2019; 39:249-255. [PMID: 31673879 DOI: 10.1007/s10096-019-03714-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.
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Affiliation(s)
- André Ricardo Araujo da Silva
- Materno-Infantil Departament, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês do Paraná 303, Niterói, RJ, 24033-900, Brazil.
| | - Elena Jaszkowski
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Tilmann Schober
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Ulrich von Both
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Melanie Meyer-Buehn
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Amanda Fáris Marques
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Beatriz Farkas
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Bernardo Silva de Abreu
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Clara Biscaia di Biase
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Jully Miyoshi Takahashi
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Luisa Dutra de Castro
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Izabel Alves Leal
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Cristiane Henriques Teixeira
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | | | - Florian Hoffmann
- Intensive Care Medicine service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Johannes Hübner
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
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