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Kampamba M, Hamaambo B, Hikaambo CN, Mwanza B, Bambala A, Mutenda M, Mukumbuta JM, Mudenda S. Evaluation of knowledge and practices on antibiotic use: a cross-sectional study on self-reported adherence to short-term antibiotic utilization among patients visiting level-1 hospitals in Lusaka, Zambia. JAC Antimicrob Resist 2024; 6:dlae120. [PMID: 39035016 PMCID: PMC11258577 DOI: 10.1093/jacamr/dlae120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a global public health problem affecting healthcare systems. Short-term antibiotic non-adherence is thought to be one of the factors contributing to antibiotic resistance. This study aimed to evaluate knowledge and practices towards short-term antibiotic use on self-reported adherence among patients visiting level-1 hospitals in Lusaka, Zambia. Methods This was a multicentre institutional-based cross-sectional study conducted among 385 adult participants from 11 September to 30 September 2023 using an adopted structured questionnaire. Analysis of the data involved descriptive and inferential statistics, where significance was determined at P < 0.05. Results Of the 335 participants, 56.7% displayed good knowledge and 77.3% low adherence towards antibiotic use. 54.6% thought that antibiotics were effective for viral infections, and 43.9% correctly recognized the definition of AMR. Being in formal employment (crude OR: 2.5, CI: 1.08-5.78, P: 0.032) was significantly associated with a higher likelihood of good knowledge about antibiotics while being divorced (adjusted OR: 2.5, CI: 1.23-6.10, P: 0.013) and having good knowledge (adjusted OR: 2.9, CI: 1.73-5.10, P = 0.048) were significantly associated with a higher likelihood of adherence to antibiotics. Regarding antibiotic practices, half (50. 0%) of the respondents had utilized antibiotics in the previous year while 58.2% had taken antibiotics for addressing a common cold. Furthermore, 74% reported to have bought antibiotics without a prescription. Conclusions This study found that participants attending level-1 hospitals had relatively good knowledge and poor adherence towards antibiotic use. Additionally, the participants demonstrated poor antibiotic use practices in almost all statements related to antibiotic usage.
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Affiliation(s)
- Martin Kampamba
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia
| | - Bubala Hamaambo
- Department of Pharmacy, School of Pharmacy, Eden University, Lusaka, Zambia
| | | | - Boris Mwanza
- Department of Pharmacy, School of Pharmacy, Eden University, Lusaka, Zambia
| | - Andrew Bambala
- Department of Pharmacy, University Teaching Hospitals, Lusaka, Zambia
| | - Mukumbi Mutenda
- Department of Pharmacy, University Teaching Hospitals, Lusaka, Zambia
| | - Jean M Mukumbuta
- Department of Pharmacy, Livingstone University Teaching Hospital, Livingstone, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O Box 50110, Lusaka, Zambia
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Sefah IA, Chetty S, Yamoah P, Godman B, Bangalee V. An Assessment of the Current Level of Implementation of the Core Elements of Antimicrobial Stewardship Programs in Public Hospitals in Ghana. Hosp Pharm 2024; 59:367-377. [PMID: 38764988 PMCID: PMC11097926 DOI: 10.1177/00185787231224066] [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] [Indexed: 05/21/2024]
Abstract
Introduction: Antimicrobial resistance (AMR) is becoming a threat to global public health. Antimicrobial stewardship (AMS) program (ASP) is one of the 5 strategic areas in the Ghana National Action Plan to fight this menace. Assessment of the core elements of ASP in a hospital setting has been identified as a pragmatic way of identifying the barriers and facilitators for its effective implementation. Method: The World Health Organization's toolkit for assessment of the 7 core elements of ASP in hospitals in low and middle income countries was used for this situational analysis of public hospitals in 2 regions of Ghana. The core elements included leadership commitment, accountability and responsibility, pharmacy expertize, AMS actions and interventions, education and training, and periodic monitoring and surveillance. Data collected using a checklist were imported into STATA version 14 for descriptive and bivariate analyses. Results: 15 public hospitals were assessed with the toolkit. Most of them were primary health care facilities (n = 12, 80.0%), had bed capacities between 100 and 199 beds, less than 50 medical doctors (n = 12, 80.0%), less than 5 pharmacists (n = 10, 66.7%), and between 100 and 199 nurses. Performances in 4 out of the 7 core elements were most deficient and they included leadership commitment, pharmacy expertize, AMS actions (interventions) implemented, monitoring and surveillance of antibiotic use, and bacteria resistance rates. Pharmacist-led ASPs were also found to be associated with their formal training on AMS. Key barriers identified included lack of skilled human resources, lack of available time for AMS-related duties and poor laboratory infrastructure. Conclusion: There was sub-optimal performance for almost all the core elements of ASP in the public hospitals in Ghana hampered mostly by lack of skilled human and financial resources. Pharmacists must be empowered through formal training and certificate programs in infectious disease management and AMS principles and strategies to enhance their contribution toward ASPs in hospitals. The results from this study should encourage nationwide assessment of ASPs across hospital settings in Ghana to better evaluate the level of their implementation and address potential barriers to guide AMS policies and ASP strategy development toward the fight against AMR.
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Affiliation(s)
- Israel Abebrese Sefah
- University of KwaZulu-Natal, Durban, South Africa
- University of Health and Allied Sciences, Volta Region, Ghana
| | | | - Peter Yamoah
- University of Health and Allied Sciences, Volta Region, Ghana
| | - Brian Godman
- Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- University of Strathclyde, Glasgow, UK
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Vu HTL, Pham TTT, Duong YH, Truong QA, Nguyen HK, Nguyen TTC, Trinh LX, Nguyen HTH, Le MQ, Vu VH, Chau DM, Huynh NT, Vo ETHD, Le HNM, Pham TN, Pollack TM, Van Doorn HR. Antibiotic prescribing practices of medical doctors in a resource-limited setting and the influence of individual perceptions and stewardship support: a survey in three tertiary hospitals in Vietnam. JAC Antimicrob Resist 2024; 6:dlae064. [PMID: 38633223 PMCID: PMC11022071 DOI: 10.1093/jacamr/dlae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
Objectives To understand antibiotic prescribing and influencing factors to inform antimicrobial stewardship (AMS) interventions to reduce unwanted consequences of antibiotic use in hospitals in Vietnam, a lower-middle-income country in Asia. Methods We conducted a cross-sectional study of doctors at three tertiary hospitals using non-probability convenience sampling, through a paper-based (Hospitals 1 and 2) or electronic (Hospital 3) survey. Questions included items on perceptions regarding antibiotic resistance and AMS, prescribing practices, knowledge, demographics and training. We used principal components analysis and mixed-effects models to examine practices and identify influencing factors. Results Among 314 surveyed participants, 61%, 57% and 59% in Hospitals 1, 2 and 3, respectively, felt certain about the appropriateness of their antibiotic prescriptions. In total, 9% reported sometimes prescribing antibiotics when not needed to meet patients' expectations, and 13% reported doing so to avoid perceived complications. Higher prescribing confidence was found among those with positive perceptions about AMS (P < 0.0001), whereas negative perceptions about colleagues' practices reduced this confidence (P < 0.0001). Individual preference for branded antibiotics was associated with more unnecessary prescribing whereas having higher prescribing confidence decreased the habits of prescribing when not needed. Conclusions This study provides important implications for design of hospital interventions to address influencing factors on antibiotic prescribing in Vietnam and similar resource-limited settings. Specific interventions should target improving knowledge through education and training for doctors, enhancing the support from the AMS team, and promoting guidelines and policies for appropriate antibiotic use in hospital.
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Affiliation(s)
- Huong Thi Lan Vu
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Thuy Thi Thanh Pham
- Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
| | - Yen Hai Duong
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Quan Anh Truong
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Hong Khanh Nguyen
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Tu Thi Cam Nguyen
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
| | - Long Xuan Trinh
- Vietnam National Children’s Hospital, 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Ha Thi Hong Nguyen
- Vietnam National Children’s Hospital, 18/879 La Thanh, Dong Da, Hanoi, Vietnam
| | - Minh Quang Le
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Vinh Hai Vu
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Duc Minh Chau
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh, Dong Thap, Vietnam
| | - Nguyet Thi Huynh
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh, Dong Thap, Vietnam
| | | | | | - Thach Ngoc Pham
- National Hospital for Tropical Diseases, 78 Giai Phong, Hanoi, Vietnam
| | - Todd M Pollack
- Partnership for Health Advancement in Vietnam, Beth Israel Deaconess Medical Center, Hanoi, Vietnam
| | - H Rogier Van Doorn
- Oxford University Clinical Research Unit, 78 Giai Phong, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Afzal S, Khan FU, Aqeel MT, Ullah M, Bajwa M, Akhtar M, Majid M. Impact of a pharmacist-led educational intervention on knowledge, attitude, and practice toward the rational use of antibiotics among healthcare workers in a secondary care hospital in Punjab, Pakistan. Front Pharmacol 2024; 14:1327576. [PMID: 38348350 PMCID: PMC10859775 DOI: 10.3389/fphar.2023.1327576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
Introduction: Growing antimicrobial resistance (AMR) and decreasing efficacy of the available antimicrobials have become a significant public health concern. The antimicrobial stewardship program (ASP) ensures the appropriate use of antimicrobials and mitigates resistance prevalence through various interventions. One of the core components of the ASP is to educate healthcare workers (HWs). Therefore, this study aims to identify the impact of a pharmacist-led educational intervention targeting knowledge, attitude, and practices regarding rational antibiotic use among healthcare professionals in a secondary care hospital in Punjab. Methods: This is a single-center, questionnaire-based, pre-post interventional study conducted over a six-month time period. Data analysis was conducted using SPSS version 26. Results: Regarding the pre-interventional knowledge, attitude, and practice (KAP) score of the respondents, 90.3% had a good knowledge score, 81.5% had a positive attitude, and 72.3% of HWs (excluding doctors) had a good practice score. Additionally, 74.6% of the doctors had a good practice score. After educational intervention, there was a significant improvement in the knowledge, attitude, and practice of the respondent HWs (p-value <0.001). Furthermore, males have higher knowledge scores compared to females in the pre- and post-intervention stages (p-value <0.05), and doctors differ from nurses regarding knowledge scores in both pre- and post-intervention stages. Conclusion: Considering educational programs as the backbone of the ASP, it is imperative to sustain efforts in the ongoing educational programs of HWs to foster high awareness and adherence to the ASP among HWs.
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Affiliation(s)
- Shairyar Afzal
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
- Department of Pharmacy, District Head Quarter Hospital Jhelum, Jhelum, Pakistan
| | - Farman Ullah Khan
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
- Pharmacy Administration and Clinical Pharmacy Xian Jiaotong University, Xi’an, China
| | | | - Matti Ullah
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
| | - Mishal Bajwa
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Masoom Akhtar
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
| | - Muhammad Majid
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
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5
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Harun MGD, Sumon SA, Hasan I, Akther FM, Islam MS, Anwar MMU. Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review. Antimicrob Resist Infect Control 2024; 13:8. [PMID: 38263235 PMCID: PMC10804809 DOI: 10.1186/s13756-024-01369-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are pivotal components of the World Health Organization's Global Action Plan to combat antimicrobial resistance (AMR). ASPs advocate rational antibiotic usage to enhance patient-centered outcomes. However, existing evidence on ASPs and their determinants is largely limited to well-equipped hospitals in high-income nations. OBJECTIVE This scoping review aimed to examine the current state of hospital-based ASPs in low- and middle-income countries (LMICs), shedding light on barriers, facilitators, prescribers' perceptions and practices, and the impact of ASP interventions. DESIGN Scoping review on ASP. METHODS Adhering to PRISMA guidelines, we conducted electronic database searches on PubMed, Scopus, and Google Scholar, covering ASP articles published between January 2015 and October 2023. Our review focused on four key domains: barriers to ASP implementation, facilitators for establishing ASP, ASP perceptions and practices of prescribers, and the impact of ASP interventions. Three reviewers separately retrieved relevant data from the included citations using EndNote 21.0. RESULTS Among the 7016 articles searched, 84 met the inclusion criteria, representing 34 LMICs. Notably, 58% (49/84) of these studies were published after 2020. Barriers to ASP implementation, including human-resources shortage, lack of microbiology laboratory support, absence of leadership, and limited governmental support, were reported by 26% (22/84) of the studies. Facilitators for hospital ASP implementation identified in five publications included the availability of antibiotic guidelines, ASP protocol, dedicated multidisciplinary ASP committee, and prompt laboratory support. The majority of the research (63%, 53/84) explored the impacts of ASP intervention on clinical, microbiological, and economic aspects. Key outcomes included increased antibiotic prescription appropriateness, reduced antimicrobial consumption, shorter hospital stays, decreased mortality rate, and reduced antibiotic therapy cost. CONCLUSIONS The published data underscores the imperative need for widespread antimicrobial stewardship in LMIC hospital settings. Substantial ASP success can be achieved through increasing human resources, context-specific interventions, the development of accessible antibiotic usage guidelines, and heightened awareness via training and education.
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Affiliation(s)
- Md Golam Dostogir Harun
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Shariful Amin Sumon
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Istiaque Hasan
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Fairoze Masuda Akther
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Mudenda S, Chisha P, Chabalenge B, Daka V, Mfune RL, Kasanga M, Kampamba M, Skosana P, Nsofu E, Hangoma J, Siachalinga L, Hikaambo CN, Chimombe T, Allabi AC, Boya B, Mufwambi W, Saleem Z, Matafwali SK. Antimicrobial stewardship: knowledge, attitudes and practices regarding antimicrobial use and resistance among non-healthcare students at the University of Zambia. JAC Antimicrob Resist 2023; 5:dlad116. [PMID: 37954639 PMCID: PMC10635582 DOI: 10.1093/jacamr/dlad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Background Antimicrobial resistance (AMR) poses a significant threat to the world and could become humanity's next major challenge. This study assessed non-healthcare students' knowledge, attitude and practices (KAP) towards antimicrobial use (AMU) and AMR at the University of Zambia. Methods This cross-sectional study was conducted among 443 non-healthcare students from August to October 2022 using a structured questionnaire. Data analysis was done using IBM SPSS version 24.0. Results Of the 433 participants, 55.2%, 63.5% and 45% had moderate KAP scores regarding AMU and AMR. The prevalence of self-medication with antibiotics was 76.7%. Male participants were less likely to have good knowledge (OR = 0.524, 95% CI: 0.347-0.792) and positive attitudes (OR = 0.585, 95% CI: 0.364-0.940) towards AMU and AMR compared with females. Students who were studying Engineering and Mining were more likely to have good knowledge of AMR (OR = 1.891, 95% CI: 1.197-2.987) compared with those in Social Sciences. Those who were in their fourth and fifth years were more likely to have positive attitudes towards AMU and AMR (OR = 1.851, 95% CI: 1.147-2.986) compared with those who were in the first, second and third years. Finally, students who practised self-medication were less likely to have good self-reported practice towards AMR (OR = 0.442, 95% CI: 0.278-0.702) compared with those who did not. Conclusions This study demonstrated that non-healthcare students had moderate KAP regarding AMU and AMR. All university students should be provided with education about AMU and AMR through free short courses, seminars, workshops, and AMR and antimicrobial stewardship awareness campaigns.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Surveillance and Research Technical Working Group, Antimicrobial Resistance, Zambia National Public Health Institute, Lusaka, Zambia
| | - Patience Chisha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Maisa Kasanga
- College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
| | - Martin Kampamba
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Eustus Nsofu
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Linda Siachalinga
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Tadious Chimombe
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Aurel Constant Allabi
- Laboratory of Pharmacology and Toxicology, University of Abomey-Calavi and Teaching Hospital of Abomey-Calavi/Sô-Ava, Abomey-Calavi, Benin
| | - Bawa Boya
- Laboratory of Biology and Molecular Typing in Microbiology, University of Abomey-Calavi, Cotonou, Benin
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Sefah IA, Chetty S, Yamoah P, Meyer JC, Chigome A, Godman B, Bangalee V. A Multicenter Cross-Sectional Survey of Knowledge, Attitude, and Practices of Healthcare Professionals towards Antimicrobial Stewardship in Ghana: Findings and Implications. Antibiotics (Basel) 2023; 12:1497. [PMID: 37887198 PMCID: PMC10604649 DOI: 10.3390/antibiotics12101497] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. A multicenter cross-sectional survey was conducted in six public hospitals in Ghana among key HCPs to assess their level of KAP towards AMS using a validated self-administered electronic questionnaire. Data analyses included descriptive and inferential statistics using STATA version 14. Overall, 339 out of 355 HCPs responded to the questionnaire, giving a response rate of 95.5%. Most responders were nurses (n = 256, 78.2%), followed by medical doctors (n = 45, 13.3%). The study recorded both poor knowledge (8.9%) and practice levels (35.4%), as well as a good attitude (78.8%) towards AMS. Ongoing exposure to AMS structured training, exposure to continuous professional development training on AMS in the previous year, and the number of years of working experience were predictors of the HCPs' level of knowledge (aOR = 3.02 C.I = 1.12-8.11), attitude (aOR = 0.37 C.I = 0.20-0.69) and practice (aOR = 2.09 C.I =1.09-3.99), respectively. Consequently, concentrated efforts must be made to address current low levels of knowledge and poor practices regarding AMS among HCPs in Ghana as part of ongoing strategies in the National Action Plan to reduce AMR.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho PMB 31, Ghana;
| | - Sarentha Chetty
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
| | - Peter Yamoah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho PMB 31, Ghana;
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa; (J.C.M.); (A.C.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa; (J.C.M.); (A.C.)
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa; (J.C.M.); (A.C.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow G4 0RE, UK
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa;
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Skosana P, Mudenda S, Demana PH, Witika BA. Exploring Nanotechnology as a Strategy to Circumvent Antimicrobial Resistance in Bone and Joint Infections. ACS OMEGA 2023; 8:15865-15882. [PMID: 37179611 PMCID: PMC10173345 DOI: 10.1021/acsomega.3c01225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023]
Abstract
Bone and joint infections (BJIs) are difficult to treat, necessitating antimicrobial therapy at high doses for an extended period of time, in some cases different from our local guidelines. As a consequence of the rise in antimicrobial-resistant organisms, drugs that were previously reserved for last-line defense are now being used as first line treatment, and the pill burden and adverse effects on patients are leading to nonadherence, encouraging antimicrobial resistance (AMR) to these last-resort medicines. Nanodrug delivery is the field of pharmaceutical sciences and drug delivery which combines nanotechnology with chemotherapy and/or diagnostics to improve treatment and diagnostic outcomes by targeting specific cells or tissues affected. Delivery systems based on lipids, polymers, metals, and sugars have been used in an attempt to provide a way around AMR. This technology has the potential to improve drug delivery by targeting the site of infection and using the appropriate amount of antibiotics to treat BJIs caused by highly resistant organisms. This Review aims to provide an in-depth examination of various nanodrug delivery systems used to target the causative agents in BJI.
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Affiliation(s)
- Phumzile
P. Skosana
- Department
of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Steward Mudenda
- Department
of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Patrick H. Demana
- Department
of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Bwalya A. Witika
- Department
of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
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Haseeb A, Saleem Z, Maqadmi AF, Allehyani RA, Mahrous AJ, Elrggal ME, Kamran SH, AlGethamy M, Naji AS, AlQarni A, Alhariqi KW, Khan MA, Ibrahim K, Raees F, Azmat A, Cook A, Campbell SM, Lorenzetti G, Meyer JC, Godman B, Moore CE. Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications. Antibiotics (Basel) 2023; 12:827. [PMID: 37237730 PMCID: PMC10215537 DOI: 10.3390/antibiotics12050827] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Aseel Fayk Maqadmi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Roaa Abdulrahman Allehyani
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
- Batterjee Medical College, Jeddah 21442, Saudi Arabia
| | - Ahmad J. Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Sairah Hafeez Kamran
- Institute of Pharmacy, Lahore College for Women University, Lahore 54000, Pakistan;
| | - Manal AlGethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia;
| | - Asem Saleh Naji
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | - Khalid W. Alhariqi
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | | | - Kiran Ibrahim
- Primary and Secondary Healthcare Department, DHQ Hospital Khushab, Khushab 41200, Pakistan;
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Aisha Azmat
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Stephen M. Campbell
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
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10
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Siachalinga L, Godman B, Mwita JC, Sefah IA, Ogunleye OO, Massele A, Lee IH. Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications. Infect Drug Resist 2023; 16:2179-2190. [PMID: 37077250 PMCID: PMC10108870 DOI: 10.2147/idr.s398223] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
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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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, 346, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, 02084, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, 100271, Nigeria
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hubert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
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11
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Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications. Antibiotics (Basel) 2023; 12:antibiotics12010135. [PMID: 36671336 PMCID: PMC9854661 DOI: 10.3390/antibiotics12010135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Antimicrobial resistance (AMR) is a leading public health threat, which is exacerbated by the high and inappropriate use of antibiotics. Consequently, there is a need to evaluate knowledge regarding antibiotic use, AMR and the readiness to implement antimicrobial stewardship programs (ASPs) among final year medical, pharmacy and nursing students in Pakistan. This reflects the high and increasing rates of AMR in the country, and students as future healthcare professionals (HCPs). A cross-sectional study was conducted among 1251 final year students from 23 public and private educational institutions in Punjab. The majority of the surveyed participants possessed good knowledge of antibiotic use, AMR and the potential causes of AMR. The most common sources of the information on antibiotics were smartphones (69.9%), peers (35.9%) and medical textbooks (30.6%). However, most surveyed participants were not fully prepared to participate in ASPs. They knew, though, how to reduce AMR by educating HCPs about appropriate prescribing, implementing ASPs and improving laboratory facilities. There was a significant association between antibiotic knowledge and causes of AMR with sex, family income and student type (p < 0.05). Being a student at a public sector university (OR = 4.809; CI = 3.261−7.094; p < 0.001) and age (OR = 0.524, CI = 0.327−0.842; p < 0.008) were among the key factors impacting students’ training on ASPs. Educational curricula must be improved to include more information about appropriate antibiotic use and ASPs, along with sufficient training, workshops and clinical rotations in the final year, to fully equip students by graduation.
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12
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Point Prevalence Survey of Antimicrobial Use during the COVID-19 Pandemic among Different Hospitals in Pakistan: Findings and Implications. Antibiotics (Basel) 2022; 12:antibiotics12010070. [PMID: 36671271 PMCID: PMC9854885 DOI: 10.3390/antibiotics12010070] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals, raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis.
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13
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Saleem Z, Godman B, Cook A, Khan MA, Campbell SM, Seaton RA, Siachalinga L, Haseeb A, Amir A, Kurdi A, Mwita JC, Sefah IA, Opanga SA, Fadare JO, Ogunleye OO, Meyer JC, Massele A, Kibuule D, Kalungia AC, Shahwan M, Nabayiga H, Pichierri G, Moore CE. Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future. Antibiotics (Basel) 2022; 11:1824. [PMID: 36551481 PMCID: PMC9774141 DOI: 10.3390/antibiotics11121824] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
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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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | | | - Stephen M. Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Ronald Andrew Seaton
- Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Linda Siachalinga
- College of Pharmacy, Yeungnam University, Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Afreenish Amir
- Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil 44001, Iraq
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0713 UB, Gaborone 00704, Botswana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Hohoe PMB 31, Ghana
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti 362103, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja 100271, Nigeria
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale P.O. Box 236, Uganda
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Moyad Shahwan
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman 346, United Arab Emirates
| | - Hellen Nabayiga
- Management Science Department, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow G4 0QU, UK
| | - Giuseppe Pichierri
- Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
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14
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Sefah IA, Akwaboah E, Sarkodie E, Godman B, Meyer JC. Evaluation of Healthcare Students' Knowledge on Antibiotic Use, Antimicrobial Resistance and Antimicrobial Stewardship Programs and Associated Factors in a Tertiary University in Ghana: Findings and Implications. Antibiotics (Basel) 2022; 11:antibiotics11121679. [PMID: 36551335 PMCID: PMC9774439 DOI: 10.3390/antibiotics11121679] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major public health problem globally, and Ghana is no exception. Good knowledge regarding antibiotic use, AMR, and the concept of antimicrobial stewardship (AMS) is critical among healthcare students to curb rising AMR rates in the future. Consequently, a need to ascertain this. A cross-sectional survey was undertaken among fifth-year pharmacy, medical students and fourth (final)-year nursing and physician assistantship students at the University of Health and Allied Sciences in Ghana to assess their knowledge on antibiotic use, AMR and AMS using a web-based self-administered structured questionnaire. Descriptive statistics, Fishers’ exact test, and multiple logistic regression analyses were performed. A total of 160 healthcare students were interviewed, of which 56.3% (n = 90) were male and 58.8% (n = 94) were in their fourth year of study. Good knowledge of antibiotic use, AMR, and AMS was associated with the study course (p = 0.001) and the number of years of study (p < 0.001). Overall, there were differences in the level of knowledge of antibiotics among the different healthcare students and their years of study. Efforts must now be made to enhance the curricula to ensure an improved and uniform transfer of knowledge of antibiotics, AMR, and AMS among the different healthcare students to sustain the fight against AMR in Ghana given growing concerns.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
| | - Emmanuel Akwaboah
- School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
| | - Emmanuel Sarkodie
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi PMB UPO KNUST, Ghana
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Correspondence: or
| | - Johanna Caterina Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
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15
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Kalungia AC, Mukosha M, Mwila C, Banda D, Mwale M, Kagulura S, Ogunleye OO, Meyer JC, Godman B. Antibiotic Use and Stewardship Indicators in the First- and Second-Level Hospitals in Zambia: Findings and Implications for the Future. Antibiotics (Basel) 2022; 11:1626. [PMID: 36421270 PMCID: PMC9687079 DOI: 10.3390/antibiotics11111626] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/07/2022] [Accepted: 11/12/2022] [Indexed: 10/21/2023] Open
Abstract
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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Affiliation(s)
- Aubrey C. Kalungia
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - David Banda
- Department of Nursing, Chreso University, Lusaka P.O. Box 37178, Zambia
| | - Matthews Mwale
- Department of Clinical Care & Diagnostic Services, Ministry of Health, Lusaka P.O Box 30205, Zambia
| | - Solomon Kagulura
- The World Bank, Zambia Country Office, Lusaka P.O Box 35410, Zambia
| | - Olanyika O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Mustafa ZU, Manzoor MN, Shahid A, Salman M, Hayat K, Yasmin K, Baraka MA, Mathew S, Kanwal M, Parveen S, Jamal I, Khan AH, Godman B, Saleem F, Bashaar M. Nurses' Perceptions, Involvement, Confidence and Perceived Barriers Towards Antimicrobial Stewardship Program in Pakistan: Findings from a Multi-Center, Cross-Sectional Study. J Multidiscip Healthc 2022; 15:2553-2562. [PMID: 36388630 PMCID: PMC9642086 DOI: 10.2147/jmdh.s376664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses' perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance. Methods A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22. Results A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP. Conclusion Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan54700, Pakistan
| | | | - Arfah Shahid
- Department of Medicine, Rawalpindi Medical University, Rawalpindi46000, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Khalida Yasmin
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Mohamed A Baraka
- Clinical Pharmacy Program, College of Pharmacy, Al Ain Campus, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Nasr city, Cairo, Egypt
| | - Smitha Mathew
- Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter Hospital, Okara South City, Pakistan
| | - Samina Parveen
- Department of Pharmacy Services, District Headquarter Hospital, Chakwal, Pakistan
| | - Irsa Jamal
- Department of Pharmacy Services, District Headquarter Hospital, Kasur, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Mohammad Bashaar
- SMART Afghan International Trainings and Consultancy, Kabul, Afghanistan
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Hospital Acquired Pathogenic Escherichia coli from Clinical and Hospital Water Samples of Quetta Balochistan. J Trop Med 2022; 2022:6495044. [PMID: 36274748 PMCID: PMC9584739 DOI: 10.1155/2022/6495044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
Abstract
A study was conducted to determine the prevalence and drug resistance of Escherichia coli present in urinary tract infected patients and hospital drinking water. A total of eighty urine samples from clinically suspected patients and thirty tap water samples from hospital vicinity were collected and analyzed for the presence of E. coli. The isolates were preliminary identified based on morphological characteristics, biochemical test and further confirmed by polymerase chain reaction (PCR) using uidA primer. Isolates were subjected to antibiogram studies and analyzed for the presence of drug resistance (ESBL blaCTX-M-15, tetA, and TMP-SMX dfrA1) and pathogenicity associated pyelonephritis-associated pili (PAP) and Heat-labile (LT) toxin genes. Urine samples 19/80 (23.75%) and water samples 8/30 (26.7%) were found contaminated with E. coli. It was found that 12/19 (63%) bacterial isolates were extended spectrum beta-lactamase (ESBL) producers in clinical and 6/8 (75%) in water isolates whereas tetracycline resistance in clinical and water isolates was 11/19 (58%) and 6/8 (75%), respectively. The trimethoprim resistance gene was confirmed in 12/19 (63%) in clinical and 2/8 (25%) in water isolates. All the clinical and water isolates were found carrying pili PAP gene. It was concluded that the presence of drug resistant and pathogenic E. coli in clinical and water samples is extremely alarming for public health due to cross contamination and bacterial transfer from clinical samples to water and vice versa.
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Tembo N, Mudenda S, Banda M, Chileshe M, Matafwali S. Knowledge, attitudes and practices on antimicrobial resistance among pharmacy personnel and nurses at a tertiary hospital in Ndola, Zambia: implications for antimicrobial stewardship programmes. JAC Antimicrob Resist 2022; 4:dlac107. [PMID: 36226225 PMCID: PMC9549736 DOI: 10.1093/jacamr/dlac107] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health problem that has led to increased morbidity and mortality, especially in low- and middle-income countries such as Zambia. This study evaluated AMR knowledge, attitudes and practices among pharmacy personnel and nurses at Ndola Teaching Hospital, Zambia's second-largest hospital. Methods A descriptive cross-sectional study was conducted among 263 participants using a structured questionnaire. Data analysis was performed with IBM SPSS version 23.0. All statistical tests were conducted at a 95% confidence level. Univariate analysis was used to determine differences in knowledge, attitudes and practices on AMR between pharmacy personnel and nurses. Results Of the 263 participants, 225 (85.6%) were nurses and 38 (14.4%) were pharmacy personnel. Compared with nurses, pharmacy personnel had better knowledge of the spread of resistant bacteria from one person to another (P = 0.001) and the use of antibiotics in livestock as a contributing factor to AMR (P = 0.01). Pharmacy personnel had better attitudes towards AMR as a public health problem (P = 0.001) and the use of antibiotics in livestock as a source of resistant pathogens (P = 001). Lastly, more pharmacy personnel than nurses participated in awareness campaigns (P = 0.029), continued professional development (P = 0.001) and courses on the use of antibiotics and AMR (P = 0.028). Conclusions The study showed that most participants had adequate knowledge, a positive attitude and good practices towards AMR. Significant differences in knowledge, attitudes and practices were observed between pharmacy personnel and nurses in AMR, highlighting a need for increased educational programmes for these healthcare personnel.
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Affiliation(s)
- Nanji Tembo
- Department of Clinical Sciences, Copperbelt University, School of Medicine, Ndola, Zambia
| | - Steward Mudenda
- Department of Pharmacy, University of Zambia, School of Health Sciences, Lusaka, Zambia
| | - Michelo Banda
- Department of Pharmacy, University of Zambia, School of Health Sciences, Lusaka, Zambia
| | - Mwitwa Chileshe
- Department of Pharmacology, Eden University, School of Pharmacy, Lusaka, Zambia
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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 in community healthcare centres across South Africa and the implications. Hosp Pract (1995) 2022; 50:306-317. [PMID: 35980901 DOI: 10.1080/21548331.2022.2114251] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in low- and middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider. METHODS A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines. RESULTS The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour®) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients' files. CONCLUSIONS It's encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.
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Affiliation(s)
- Phumzile P Skosana
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, 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, United Arab Emirates
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Danie Kruger
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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20
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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: 45] [Impact Index Per Article: 22.5] [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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21
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Alshaikh FS, Godman B, Sindi ON, Seaton RA, Kurdi A. Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis. PLoS One 2022; 17:e0272375. [PMID: 35913964 PMCID: PMC9342726 DOI: 10.1371/journal.pone.0272375] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR). AIM To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients. DATA SOURCE OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. STUDY ELIGIBILITY English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. PARTICIPANTS Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting. METHODS Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design. RESULTS A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26-10.31) and 61.77% (CI 50.95-70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30-14.18). CONCLUSION Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.
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Affiliation(s)
- Faisal Salman Alshaikh
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Pharmaceutical Services, Bahrain Defence Force Military Hospital, Riffa, Kingdom of Bahrain
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Oula Nawaf Sindi
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Pharmaceutical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
| | - R. Andrew Seaton
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Kurdistan Region Government, Iraq
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region Government, Iraq
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22
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Exploring Knowledge of Antibiotic Use, Resistance, and Stewardship Programs among Pharmacy Technicians Serving in Ambulatory Care Settings in Pakistan and the Implications. Antibiotics (Basel) 2022; 11:antibiotics11070921. [PMID: 35884175 PMCID: PMC9311796 DOI: 10.3390/antibiotics11070921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Abstract
Antimicrobial resistance (AMR) is a leading global health threat, increasing morbidity, mortality, and costs, with excessive and irrational use of antimicrobials contributing to the development of AMR. Consequently, the aims of this study were to evaluate the understanding of antibiotic use, AMR, and antimicrobial stewardship programs (ASPs) among pharmacy technicians serving in ambulatory healthcare settings in Pakistan. A cross-sectional survey was conducted among pharmacy technicians serving in 144 ambulatory care settings in seven districts of Punjab province using a validated questionnaire. Overall, 376 technicians completed the survey (85.8% response rate). The majority were men (89.1%), aged 25−35 years (45.1%), serving in emergency departments (43.9%) and filling 31−60 prescriptions per day (37.5%). Most (79.5%) knew that antibiotics were one of the most frequently prescribed drug classes, while 59.8% believed antibiotics for common colds did not speed up recovery. Inadequate duration (59.6%) and inadequate dosages (57.7%) of antibiotic therapy were reported as the leading causes of AMR. Terms including ‘superbugs’, ‘multidrug resistance’, and ‘extensively drug resistance’ were known to 42.0%, 25.3%, and 20.7% of participants, respectively; however, <10% knew about ASPs, including their core elements and purpose. Our study revealed that pharmacy technicians have adequate awareness of antibiotic use but are currently unaware of AMR and ASPs, which is a concern.
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Alabi AS, Picka SW, Sirleaf R, Ntirenganya PR, Ayebare A, Correa N, Anyango S, Ekwen G, Agu E, Cook R, Yarngrorble J, Sanoe I, Dugulu H, Wiefue E, Gahn-Smith D, Kateh FN, Hallie EF, Sidonie CG, Aboderin AO, Vassellee D, Bishop D, Lohmann D, Naumann-Hustedt M, Dörlemann A, Schaumburg F. Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned. JAC Antimicrob Resist 2022; 4:dlac069. [PMID: 35769809 PMCID: PMC9226657 DOI: 10.1093/jacamr/dlac069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 11/14/2022] Open
Abstract
Background Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs). Objectives To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals. Methods A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use. Results The majority of patients had skin and soft tissue infections (n = 108) followed by surgical site infections (n = 72), pneumonia (n = 64), urinary tract infection (n = 48) and meningitis (n = 18). After the AMS ward rounds, 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). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P < 0.0005). Conclusions AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.
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Affiliation(s)
- Abraham S Alabi
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Stephen W Picka
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Reubvera Sirleaf
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | | | - Arnold Ayebare
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | | | - Sarah Anyango
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | - Gerald Ekwen
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
| | - Emmanuel Agu
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | - Rebecca Cook
- Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia
- Partners In Health, Boston, MA, USA
| | | | - Ibrahim Sanoe
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | - Henry Dugulu
- Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia
| | | | | | | | | | | | | | - David Vassellee
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | - Damien Bishop
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | - Daniel Lohmann
- German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia
| | | | - Alois Dörlemann
- Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University of Münster, Münster, Germany
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24
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Setiawan E, Abdul-Aziz MH, Roberts JA, Cotta MO. Hospital-Based Antimicrobial Stewardship Programs Used in Low- and Middle-Income Countries: A Scoping Review. Microb Drug Resist 2022; 28:566-584. [PMID: 35333607 DOI: 10.1089/mdr.2021.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database inception until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability-Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive-based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimicrobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.
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Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Clinical and Community Pharmacy; and Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, Surabaya, Indonesia
| | - Mohd-Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Kimbowa IM, Eriksen J, Nakafeero M, Obua C, Lundborg CS, Kalyango J, Ocan M. Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda. PLoS One 2022; 17:e0262993. [PMID: 35113932 PMCID: PMC8812957 DOI: 10.1371/journal.pone.0262993] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Though antimicrobial stewardship (AMS) programmes are the cornerstone of Uganda's national action plan (NAP) on antimicrobial resistance, there is limited evidence on AMS attitude and practices among healthcare providers in health facilities in Uganda. We determined healthcare providers' AMS attitudes, practices, and associated factors in selected health facilities in Uganda. We conducted a cross-sectional study among nurses, clinical officers, pharmacy technicians, medical officers, pharmacists, and medical specialists in 32 selected health facilities in Uganda. Data were collected once from each healthcare provider in the period from October 2019 to February 2020. Data were collected using an interview-administered questionnaire. AMS attitude and practice were analysed using descriptive statistics, where scores of AMS attitude and practices for healthcare providers were classified into high, fair, and low using a modified Blooms categorisation. Associations of AMS attitude and practice scores were determined using ordinal logistic regression. This study reported estimates of AMS attitude and practices, and odds ratios with 95% confidence intervals were reported. We adjusted for clustering at the health facility level using clustered robust standard errors. A total of 582 healthcare providers in 32 healthcare facilities were recruited into the study. More than half of the respondents (58%,340/582) had a high AMS attitude. Being a female (aOR: 0.66, 95% CI: 0.47-0.92, P < 0.016), having a bachelor's degree (aOR: 1.81, 95% CI: 1.24-2.63, P < 0.002) or master's (aOR: 2.06, 95% CI: 1.13-3.75, P < 0.018) were significant predictors of high AMS attitude. Most (46%, 261/582) healthcare providers had fair AMS practices. Healthcare providers in the western region's health facilities were less likely to have a high AMS practice (aOR: 0.52, 95% CI 0.34-0.79, P < 0.002). In this study, most healthcare providers in health facilities had a high AMS attitude and fair AMS practice.
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Affiliation(s)
- Isaac Magulu Kimbowa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Unit of Infectious diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mary Nakafeero
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joan Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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Haque M, Godman B, Sharma P, Chowdhury K, Kumar S, Bhatt R, Hirani T, Duseja S, Lutfor A, Etando A, Škrbić R, Shahwan M, Jairoun A. A pilot study regarding the consequences of the COVID-19 pandemic on healthcare education in India and the implications. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_34_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bahrampour Juybari K, Vosooghi V, Zahmatkesh M, Mirmohammadkhani M, Paknazar F. Compliance of imipenem and meropenem administration with the national antimicrobial stewardship program in a referral teaching hospital in Iran. Hosp Pract (1995) 2021; 50:49-54. [PMID: 34958614 DOI: 10.1080/21548331.2021.2022358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Considering the great significance of antimicrobial resistance, implementation of antimicrobial stewardship programs (ASPs) in healthcare facilities is of particular importance. This study aimed to evaluate the compliance of imipenem and meropenem administration with the ASP guidelines in a referral teaching hospital in Iran. METHODS In this retrospective cross-sectional study, the medical records of patients, who received either imipenem or meropenem at xx Hospital in Semnan, Iran, from March 21, 2017 until March 20, 2019, were reviewed using the developed ASP, according to the instructions issued by the Ministry of Health of Iran. The obtained findings were recorded in a checklist consisted of six items. If the action taken for the patient complied with the item requirement specified in the ASP, it would receive a score of one; otherwise, a score of zero. The sum of scores (range: 0-6) was reported and analyzed. Data were analyzed in SPSS version 23, using Chi-square, ANOVA, and independent t-test, and P <0.05 was considered as significant. RESULTS The mean duration of imipenem/meropenem administration was 9.2±8.0 days. A total of 6,032 imipenem/meropenem vials (1 g/vial) were prescribed during the study (meropenem for 210 patients and imipenem for 87 patients). In 64.2% of the patients, there was no indication, and the mean score of the subjects was 1.55±1.2. The obtained score was three in 53 (17.8%) records and four in 18 (6.1%) records. The mean score of ASP in the intensive care units was higher, while it was lower in the surgical ward as compared to the other wards (P=0.002). DISCUSSION Antibiotic prescription was inappropriate in our center, and compliance with the ASP guidelines was very low, especially in the surgical wards. It seems necessary to take effective steps for planning continuing education programs on rational antibiotic prescription and supervision of prescription patterns.
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Affiliation(s)
- Kobra Bahrampour Juybari
- Department of Pharmacology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Vaice Vosooghi
- School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Mehrdad Zahmatkesh
- Internal Medicine Department, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Fatemeh Paknazar
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
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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: 19] [Impact Index Per Article: 6.3] [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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Aleem M, Azeem AR, Rahmatullah S, Vohra S, Nasir S, Andleeb S. Prevalence of Bacteria and Antimicrobial Resistance Genes in Hospital Water and Surfaces. Cureus 2021; 13:e18738. [PMID: 34790487 PMCID: PMC8587521 DOI: 10.7759/cureus.18738] [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] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose Antimicrobial resistance (AMR) has become a worldwide environmental and public health problem, causing more than 250,000 deaths per year. Unregulated usage, unsafe hospital practices, and misuse in veterinary contribute to the development of multidrug resistance in various bacteria. Hospital water was hypothesized to be a hotspot for AMR transmission because of (1) increased exposure to antibiotic load, (2) poor drainage and sanitation system, (3) interaction between environmental and clinical microbes. The purpose of the research was to assess the biodiversity and AMR in hospital tap waters. Methodology In this study, the microflora of the hospital tap water and hospital surfaces was observed by obtaining water samples from the intensive care unit (ICU), surgical wards, and washrooms. These were processed through membrane filtration and spread on seven different media (Aeromonas Medium, Azide Dextrose Agar, MacConkey Agar, Mannitol Salt Agar, Pseudomonas Cetrimide Agar, Salmonella Shigella Agar, and Thiosulfate Citrate Bile Salts Sucrose Agar). Surface samples were collected from the faucet, basin, and drain and directly spread on the media plates. Isolates were identified using standard bacteriological and biochemical tests. Kirby-Bauer disk diffusion method was performed using 21 antibiotic disks from 10 different antibiotic classes. They included ampicillin (AMP), amoxicillin (AML), piperacillin-tazobactam (TZP), cefipime (FEP), cefoxitin (FOX), ceftazidime (CAZ), ceftriaxone (CRO), imipenem (IMP), meropenem (MEM), ciprofloxacin (CIP), moxifloxacin (MXF), levofloxacin (LEV), amikacin (AK), gentamicin (CN), tigecycline (TGC), aztreonam (ATM), erythromycin (E), clindamycin (DA), rifampicin (RD), colistin (CT), and chloramphenicol (C). The results were interpreted according to EUCAST guidelines for the antibiogram of the isolates; 38 isolates were selected out of 162 based on different parameters for genotyping and detection of six beta-lactamase genes (blaSHV, blaTEM, blaCTX-M, blaOXA, blaKPC, blaNDM). Results Among these 162 isolates, 82 were obtained from water sources and 80 were collected from surfaces (faucet, basin, drain). The isolates included a variety of bacteria including Aeromonas spp. (20%), Klebsiella spp. (13%), Staphylococcus aureus (13%), Pseudomonas spp.(10%), Escherichia coli (9%), Vibrio spp. (8%), Enterococcus spp. (6%), Shigella spp. (6%), Salmonella spp. (4%), Acinetobacter spp. (3%), Staphylococcus epidermitis (3%), Streptococci spp. (2%), Proteus spp. (1%), Citrobacter spp. (1%), and Serratia spp. (1%). A diverse range of microbes were identified including clinically relevant bacteria, which shows that the urban water cycle is already contaminated with multidrug-resistant microflora of the hospital settings. Macrolide and lincosamide showed the highest resistance followed by penicillin, monobactam, and cephalosporins. blaSHV and blaTEM were prevalent in samples. blaNDM was also found which manifests as a real threat since it causes resistance against carbapenems and colistin, antibiotics reserved as a last resort against infections. Conclusions This study presented the ground reality of antibiotic resistance in Pakistan and how its subsequent spread poses a great threat to the strides made in the field of medicine and public health. Strict regulations regarding antibiotic usage, hospital effluent, and urban water sanitation must be imposed to curb the devastating effects of this increasing phenomenon.
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Affiliation(s)
- Maira Aleem
- Biotechnology, Combined Military Hospital (CMH) - Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Abdul R Azeem
- General Medicine, Combined Military Hospital (CMH), Lahore, PAK
| | - Sidra Rahmatullah
- Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, PAK
| | - Sufyan Vohra
- Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, PAK
| | - Shumyila Nasir
- Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, PAK
| | - Saadia Andleeb
- Atta-ur-Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, PAK
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Akande-Sholabi W, Ajamu AT. Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University. BMC MEDICAL EDUCATION 2021; 21:488. [PMID: 34507579 PMCID: PMC8434738 DOI: 10.1186/s12909-021-02912-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/28/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University. METHODS Respondents' knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents' knowledge. RESULTS Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7-22.96)], had greater knowledge of antimicrobial resistance. CONCLUSIONS The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.
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Affiliation(s)
- Wuraola Akande-Sholabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Amen T. Ajamu
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Engler D, Meyer JC, Schellack N, Kurdi A, Godman B. Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction. Antibiotics (Basel) 2021; 10:antibiotics10080996. [PMID: 34439046 PMCID: PMC8388942 DOI: 10.3390/antibiotics10080996] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.
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Affiliation(s)
- Deirdré Engler
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Correspondence:
| | - Johanna Catharina Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Arcadia 0007, South Africa;
| | - Amanj Kurdi
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0204, South Africa; (J.C.M.); (A.K.); (B.G.)
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow G4 0RE, UK
- School of Pharmaceutical Sciences, University Sains Malaysia, George Town 118000, PNG, Malaysia
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Saleem Z, Godman B, Azhar F, Kalungia AC, Fadare J, Opanga S, Markovic-Pekovic V, Hoxha I, Saeed A, Al-Gethamy M, Haseeb A, Salman M, Khan AA, Nadeem MU, Rehman IU, Qamar MU, Amir A, Ikram A, Hassali MA. Progress on the national action plan of Pakistan on antimicrobial resistance (AMR): a narrative review and the implications. Expert Rev Anti Infect Ther 2021; 20:71-93. [PMID: 34038294 DOI: 10.1080/14787210.2021.1935238] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: The emergence of antimicrobial resistance (AMR) is a threat to public health. In 2015, the World Health Organization (WHO) introduced a global action plan to tackle AMR in the World Health Assembly. Pakistan's national action plan (NAP) for AMR was released in May 2017 by the Ministry of National Health Services. Based on the NAP, strategies have been initiated on a national and provincial scale in Pakistan.Areas covered: This narrative review of the five components of the Pakistan NAP has been undertaken to discuss some of the challenges in implementation of the NAP for AMR in Pakistan including different opinions and views of key stakeholders, combined with suggestions on potential ways to reduce the burden of the AMR.Expert opinion: Going forward, healthcare authorities should focus on screening and monitoring of all the objectives of the NAP by establishing proper policies as well as promoting antimicrobial stewardship interventions and Infection prevention and control (IPC) practices. Overall, the comprehensive strengthening of the healthcare system is required to adequately implement the NAP, tackle continued inappropriate antimicrobial use and high AMR rates in Pakistan.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town Malaysia
| | - Faiza Azhar
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Vanda Markovic-Pekovic
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Amna Saeed
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Manal Al-Gethamy
- Alnoor Specialist Hospital Makkah, Department of Infection Prevention & Control Program, Makkah, Kingdom of Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Kingdom of Saudi Arabia
| | - Muhammad Salman
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Ayaz Ali Khan
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Muhammad Umer Nadeem
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Inaam Ur Rehman
- Department of Pharmaceutical Chemistry, University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Muhammad Usman Qamar
- Department of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National Institute of Health Islamabad, Pakistan
| | - Aamer Ikram
- Department of Microbiology, National Institute of Health Islamabad, Pakistan
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Kasanga M, Mukosha R, Kasanga M, Siyanga M, Mudenda S, Solochi BB, Chileshe M, Mwiikisa MJ, Gondwe T, Kantenga T, Shibemba AL, Nakazwe R, Chitalu M, Wu J. Antimicrobial resistance patterns of bacterial pathogens their distribution in university teaching hospitals in Zambia. Future Microbiol 2021; 16:811-824. [PMID: 34184556 DOI: 10.2217/fmb-2021-0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To determine the antimicrobial resistance patterns of bacterial pathogens from urine, blood and wound infections and their distribution by age, sex and location. Materials & methods: A total of 49,168 samples were collected, processed and analyzed. Results: Multidrug resistance was observed in almost all bacterial pathogens in blood urine and wound swabs. In urine and females odds ratio (OR) = 0.864, p = 0.023, OR = 0.909, p = 0.013 urine and neonates were susceptible to antibiotics OR = 0.859, p = 0.003, OR = 0.741, p < 0.001. Ampicillin resistance was above 90% against Escherichia coli in blood, urine and wound swabs. Conclusion: There was a spike in resistance to imipenem, ciprofloxacin and ampicillin against E. coli, Klebsiella pneumoniae, Proteus mirabilis and Proteus species from all three specimen sources.
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Affiliation(s)
- Maisa Kasanga
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China.,Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Raphael Mukosha
- Levy Mwanawasa University Teaching Hospital, Laboratory Department, Great East Road, Chainama Area, Lusaka, 3170151, Zambia
| | - Maika Kasanga
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Makomani Siyanga
- Zambia Medicines Regulatory Authority, Plot No. 2350/M, Off KK International Airport Road, Lusaka, 31890, Zambia
| | - Steward Mudenda
- Department of Pharmacy, The University of Zambia, School of Health Sciences, Lusaka, 50110, Zambia.,Department of Disease Control, The University of Zambia, School of Veterinary Medicine, Lusaka, 32379, Zambia
| | - Benjamin Bisesa Solochi
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Misheck Chileshe
- Department of Mary Begg Health Services Laboratory, 56 Chintu Avenue, Northrise, Ndola, 72221, Zambia
| | - Mark J Mwiikisa
- Department of Lusaka Trust Hospital Laboratory, Plot 2190, Nsumbu Rd, Woodlands, Lusaka Main, Lusaka, 35852, Zambia
| | - Theodore Gondwe
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
| | - Timothy Kantenga
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Aaron Lunda Shibemba
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia.,Directorate of Clinical Pathology & Laboratory Services, Ministry of Health, Lusaka, Zambia
| | - Ruth Nakazwe
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Mwansa Chitalu
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Jian Wu
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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Rijal KR, Banjara MR, Dhungel B, Kafle S, Gautam K, Ghimire B, Ghimire P, Dhungel S, Adhikari N, Shrestha UT, Sunuwar DR, Adhikari B, Ghimire P. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep 2021; 11:11554. [PMID: 34078956 PMCID: PMC8172831 DOI: 10.1038/s41598-021-90812-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6-4.4)], versus secondary education (8-10 grade) [AOR = 1.8 (95% Cl = 1.0-3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.
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Affiliation(s)
- Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Samarpan Kafle
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Kedar Gautam
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bindu Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | | | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Dev Ram Sunuwar
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
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Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med 2021; 14:515-530. [PMID: 33633461 PMCID: PMC7901404 DOI: 10.2147/ijgm.s253216] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a concern with the growing use of antimicrobials across countries increasing antimicrobial resistance (AMR) rates. A key area within hospitals is their use for the prevention of surgical site infections (SSI) with concerns with timing of the first dose, which can appreciably impact on effectiveness, as well as duration with extended prophylaxis common among low- and middle-income countries (LMICs). This is a concern as extended duration increases utilization rates and AMR as well as adverse events. Consequently, there is a need to document issues of timing and duration of surgical antibiotic prophylaxis (SAP) among LMICs together with potential ways forward to address current concerns. METHODS Narrative review of timings and duration of SAP among LMICs combined with publications documenting successful approaches to improve SAP to provide future direction to all key stakeholder groups. RESULTS There were documented concerns with the timing of the first dose of antibiotics, with appropriate timing as low as 6.7% in Egypt, although as high as 81.9% in Turkey. There was also an extensive duration of SAP, ranging from long duration times in all patients in a study in Nigeria with a mean of 8.7 days and 97% of patients in Egypt to 42.9% of patients in Pakistan and 35% in Turkey. Successful interventions to improve SAP typically involved multiple approaches including education of all key stakeholder groups, monitoring of usage against agreed guidelines,as well as quality targets. Multiple approaches typically improved timing and duration as well as reduced costs. For instance, in one study appropriateness increased from 30.1% to 91.4%, prolonged duration reduced to 5.7% of patients, and mean costs of antibiotics decreased 11-fold. CONCLUSION There are considerable concerns with the timing and duration of SAP among LMICs. Multiple interventions among LMICs can address this providing future directions.
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Affiliation(s)
- Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Centre for Genomics of Non-Diseases and Personalized Healthcare (CGNPH), University of Lagos, Lagos, Nigeria
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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37
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Mufwambi W, Stingl J, Masimirembwa C, Manasa J, Nhachi C, Stadler N, Mwila C, Kalungia AC, Mukosha M, Mutiti CS, Kamoto A, Kaonga P, Godman B, Munkombwe D. Healthcare Professionals' Knowledge of Pharmacogenetics and Attitudes Towards Antimicrobial Utilization in Zambia: Implications for a Precision Medicine Approach to Reducing Antimicrobial Resistance. Front Pharmacol 2021; 11:551522. [PMID: 33510634 PMCID: PMC7835886 DOI: 10.3389/fphar.2020.551522] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/25/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction: Sub-Saharan Africa and other low- and middle-income countries (LMICs) have the highest rates of antimicrobial resistance (AMR) driven by high rates of antimicrobial utilization. This is a concern as AMR appreciably increases morbidity, mortality and costs. Pharmacogenetics (PGx) and precision medicine are emerging approaches to combat AMR. Consequently, as a first step there is a need to assess AMR knowledge and attitudes, and knowledge of PGx, among healthcare professionals and use the findings to guide future interventions. Methodology: We conducted a cross-sectional study involving 304 healthcare professionals at tertiary hospitals in Lusaka, Zambia. Structural Equation Modeling (SEM) was used to analyze relationships among latent variables. Results: Overall correctness of answers concerning AMR among healthcare professionals was 60.4% (7/11). Knowledge of pharmacogenetics was low (38%). SEM showed that high AMR knowledge score correlated with a positive attitude toward combating AMR (p < 0.001). Pharmacists had relatively higher AMR knowledge scores (mean = 7.67, SD = 1.1), whereas nurses had lower scores (mean = 5.57, SD = 1.9). A minority of respondents [31.5% (n = 95)] indicated that poor access to local antibiogram data promoted AMR, with the majority [56.5% (n = 190)] responding that poor adherence to prescribed antimicrobials can lead to AMR. Pharmacists had the highest scores for attitude (mean = 5.60, SD = 1.6) whereas nurses had the lowest scores (mean = 4.02, SD = 1.4). Conclusion: AMR knowledge and attitudes, as well as knowledge on PGx among healthcare professionals in Zambia, is sub-optimal and has the potential to affect the uptake of precision medicine approaches to reduce AMR rates. Educational and positive behavioral change interventions are required to address this and in future, we will be seeking to introduce these to improve the use of antimicrobials.
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Affiliation(s)
- Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- African Institute of Biomedical Science and Technology, Harare, Zimbabwe
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Julia Stingl
- RWTH University Hospital Aachen, Aachen, Germany
| | | | - Justen Manasa
- African Institute of Biomedical Science and Technology, Harare, Zimbabwe
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Charles Nhachi
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Nadina Stadler
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - Chiluba Mwila
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Chenai S. Mutiti
- African Institute of Biomedical Science and Technology, Harare, Zimbabwe
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Alfred Kamoto
- African Institute of Biomedical Science and Technology, Harare, Zimbabwe
- University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Patrick Kaonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Tropical Gastroenterology and Nutrition Group, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Brian Godman
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Rankuwa, South Africa
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Derick Munkombwe
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
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38
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Godman B, Sefah I, Essah D, Haque M, Opanga S, Kumar S, Chikowe I, Kibuule D, Rampamba E, Kalungia A, Thi Phuong T, Saleem Z, Markovic-Pekovic V, Kurdi A. COVID-19, health care and self-medication issues in resource-limited settings: Findings and implications based on experiences in Ghana. ADVANCES IN HUMAN BIOLOGY 2021. [DOI: 10.4103/aihb.aihb_82_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Chen J, Sidibi AM, Shen X, Dao K, Maiga A, Xie Y, Hesketh T. Lack of antibiotic knowledge and misuse of antibiotics by medical students in Mali: a cross-sectional study. Expert Rev Anti Infect Ther 2020; 19:797-804. [PMID: 33251896 DOI: 10.1080/14787210.2021.1857731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: Misuse of antibiotics, especially in low-and-middle-income countries is a major contributor to antimicrobial resistance. Medical students are antibiotic consumers and prescribers in the future. This study aimed to assess antibiotic knowledge and utilization among medical students in the Republic of Mali, and to determine the relationship between knowledge and health-seeking behavior in relation to antibiotic use.Methods: A cross-sectional survey was conducted in the only public medical university in Mali. The questionnaire explored knowledge about antibiotics of medical students, and health behaviors for self-limiting illness. Data were analyzed in SPSS.Results: A total of 446 medical students completed the questionnaire. The average knowledge score was 4.12 out of 10. Students with clinical experience performed higher (4.79 vs 3.74, p< 0.01); 391(87.7%) medical students reported experience of self-limiting diseases in the past year. Of these 197(50.4%) went to see a doctor, 160 (81.2%) of whom were prescribed antibiotics: 151 medical students self-treated, with 121(80.1%) using antibiotics.Conclusions: This study shows poor knowledge and massive misuse of antibiotics among medical students in Mali. Promoting education on the mechanism of antibiotics, antimicrobial resistance and rational antibiotic use among medical students should be a priority in the medical school curriculum.
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Affiliation(s)
- Jie Chen
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Xiaohui Shen
- Institute for Global Health, University College London,London, UK
| | - Kalo Dao
- Department of Tropical Infectious Diseases, University of Science, Technique and Technologies of Bamako, Bamako, Mali
| | - Alain Maiga
- Department of Tropical Infectious Diseases, University of Science, Technique and Technologies of Bamako, Bamako, Mali
| | - Ying Xie
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Therese Hesketh
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou, China.,Institute for Global Health, University College London,London, UK
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40
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Kasanga M, Mudenda S, Siyanga M, Chileshe M, Mwiikisa MJ, Kasanga M, Solochi BB, Gondwe T, Kantenga T, L Shibemba A, Chitalu M, Nakazwe R, Wu J. Antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia at a tertiary hospital in Zambia. Future Microbiol 2020; 15:1735-1745. [PMID: 33315486 DOI: 10.2217/fmb-2020-0250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Bloodstream infections and antimicrobial resistance cause global increases in morbidity and mortality. Aim: We evaluated the antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia in humans. Materials & methods: We conducted a retrospective cross-sectional study at the University Teaching Hospitals in Lusaka, Zambia, using Laboratory Information Systems. Results: The commonest isolated bacteria associated with sepsis were Klebsiella pneumoniae. The distribution of bacteria associated with bacteremia in different wards and departments pneumonia. The distribution of bacteria associated with bacteremia in different wards and departments at University Teaching Hospitals was were statistically significant (χ2 = 1211.518; p < 0.001). Conclusion: K. pneumoniae, Escherichia coli, Pantoea agglomerans and Enterococcus species have developed high resistance levels against ampicillin, cefotaxime, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole and a very low resistance levels against imipenem and Amikacin.
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Affiliation(s)
- Maisa Kasanga
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China.,University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Steward Mudenda
- The University of Zambia, School of Health Sciences, Department of Pharmacy, PO Box 50110, Lusaka, Zambia.,The University of Zambia, School of Veterinary Medicine, Department of Disease Control, PO Box 32379, Lusaka, Zambia
| | - Makomani Siyanga
- Zambia Medicines Regulatory Authority, Plot No. 2350/M, Off KK International Airport Road, PO Box 31890 Lusaka
| | - Misheck Chileshe
- Mary Begg Health Services, 56 Chintu Avenue, Northrise, PO Box 72221, Ndola
| | - Mark J Mwiikisa
- Lusaka Trust Hospital, Plot 2190, Nsumbu Rd, Woodlands, PO Box 35852, Lusaka Main, Lusaka, Zambia
| | - Maika Kasanga
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | | | - Theodore Gondwe
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China
| | | | - Aaron L Shibemba
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia.,Directorate of Clinical Pathology & Laboratory Services, Ministry of Health, Lusaka
| | - Mwansa Chitalu
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Ruth Nakazwe
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Jian Wu
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China
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Babatola AO, Fadare JO, Olatunya OS, Obiako R, Enwere O, Kalungia A, Ojo TO, Sunmonu TA, Desalu O, Godman B. Addressing antimicrobial resistance in Nigerian hospitals: exploring physicians prescribing behavior, knowledge, and perception of antimicrobial resistance and stewardship programs. Expert Rev Anti Infect Ther 2020; 19:537-546. [PMID: 32990480 DOI: 10.1080/14787210.2021.1829474] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We assessed the knowledge of, attitude toward antimicrobial resistance (AMR) and practice of antimicrobial stewardship (AMS) among physicians in Nigeria to provide future guidance to the Nigerian National Action Plan for AMR. METHODS A descriptive cross-sectional questionnaire-based study explored the physicians' self-reported practice of antibiotic prescribing, knowledge, attitude, and practice of AMR and components of ASPs. RESULTS The majority (217; 67.2%) of respondents prescribed antibiotics daily in their clinical practice AMR was recognized as a global and local problem by 308 (95.4%) and 262 (81.1%) respondents, respectively. Only 91 (28.2%) of respondents have ever heard of antibiotic stewardship. The median AMR knowledge score was 40 (19-45)out of 45while that for ASP was 46.0(32-57) out of 60. There was significant statistical difference between the ASP median scores among the medical specialties category (P value <0.0001) More respondents had good knowledge of AMR than ASPs (82.7% versus 36.5%; p < 0.0001). CONCLUSION Respondents in this study were more knowledgeable about AMR than AMS and its core components.
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Affiliation(s)
- Adefunke O Babatola
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladele S Olatunya
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Reginald Obiako
- Department of Clinical Pharmacology, Ahmadu Bello University, Zaria, Nigeria.,Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Okezie Enwere
- Department of Medicine, Imo State University, Orlu, Nigeria
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Temitope O Ojo
- Department of Community Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olufemi Desalu
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Mohammed ZA, Mukhopadhyay C, Varma M, Kalwaje Eshwara V. Identifying opportunities for antimicrobial stewardship through a point prevalence survey in an Indian tertiary-care teaching hospital. J Glob Antimicrob Resist 2020; 23:315-320. [PMID: 33199265 DOI: 10.1016/j.jgar.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 08/04/2020] [Accepted: 09/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Unregulated and inappropriate use of antimicrobial agents has been a major driver of antimicrobial resistance with a dangerous impact on health issues in developing nations. We report an audit of antimicrobial use patterns in a tertiary-care teaching hospital in order to identify opportunities for antimicrobial stewardship. METHODS A point prevalence survey was conducted to study the use of ten selected antibiotics in various adult inpatient facilities. Patient characteristics as well as indications and patterns of antibiotic prescription were recorded. RESULTS A total of 188 patients received any one of the survey antibiotics, accounting for 43% of patients admitted under the study specialties. Of the 188 patients, 59% were admitted in non-intensive care unit settings. The median (interquartile range) duration of hospitalisation during the survey was 8 (4.75) days. Intra-abdominal infections (75; 40%) and respiratory infections (41; 22%) were the most common reasons for admission. Empirical antibiotic use was observed in 66% of patients. Antimicrobial use without any microbiological test was evidenced in 32 patients (17%). Significant differences were noted between medical and surgical specialties in choice of antibiotic, dosage and utilisation of microbiological tests. CONCLUSIONS High empirical antibiotic use, poor transition from empirical to rational use, and underutilisation of microbiological tests were noted. The choice of antibiotics differed among specialties. Inappropriate dosing was greater in surgical specialties, especially with aminoglycosides. Adherence to local antibiotic policy, optimal dosing and audit of reserved antibiotic use can be useful approaches to strengthen antimicrobial stewardship programmes.
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Affiliation(s)
- Zabiuddin Ahad Mohammed
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India; Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Muralidhar Varma
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India; Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Vandana Kalwaje Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India.
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Elton L, Thomason MJ, Tembo J, Velavan TP, Pallerla SR, Arruda LB, Vairo F, Montaldo C, Ntoumi F, Abdel Hamid MM, Haider N, Kock R, Ippolito G, Zumla A, McHugh TD. Antimicrobial resistance preparedness in sub-Saharan African countries. Antimicrob Resist Infect Control 2020; 9:145. [PMID: 32859252 PMCID: PMC7456056 DOI: 10.1186/s13756-020-00800-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is of growing concern globally and AMR status in sub-Saharan Africa (SSA) is undefined due to a lack of real-time data recording, surveillance and regulation. World Health Organization (WHO) Joint External Evaluation (JEE) reports are voluntary, collaborative processes to assess country capacities and preparedness to prevent, detect and rapidly respond to public health risks, including AMR. The data from SSA JEE reports were analysed to gain an overview of how SSA is working towards AMR preparedness and where strengths and weaknesses lie. METHODS SSA country JEE AMR preparedness scores were analysed. A cumulative mean of all the SSA country AMR preparedness scores was calculated and compared to the overall mean SSA JEE score. AMR preparedness indicators were analysed, and data were weighted by region. FINDINGS The mean SSA AMR preparedness score was 53% less than the overall mean SSA JEE score. East Africa had the highest percentage of countries reporting having AMR National Action Plans in place, as well as human and animal pathogen AMR surveillance programmes. Southern Africa reported the highest percentage of countries with training programmes and antimicrobial stewardship. CONCLUSIONS The low mean AMR preparedness score compared to overall JEE score, along with the majority of countries lacking implemented National Action Plans, suggests that until now AMR has not been a priority for most SSA countries. By identifying regional and One Health strengths, AMR preparedness can be fortified across SSA with a multisectoral approach.
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Affiliation(s)
| | | | | | | | | | | | - Francesco Vairo
- National Institute for Infectious Diseases Lazzaro Spallanzani Institute for Hospitalization and Care Scientific, Rome, Italy
| | - Chiara Montaldo
- National Institute for Infectious Diseases Lazzaro Spallanzani Institute for Hospitalization and Care Scientific, Rome, Italy
| | - Francine Ntoumi
- University of Tübingen, Tübingen, Germany
- Congolese Foundation for Medical Research, Brazzaville, Republic of Congo
| | | | | | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani Institute for Hospitalization and Care Scientific, Rome, Italy
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Nusrat T, Akter N, Rahman NAA, Godman B, D Rozario DT, Haque M. Antibiotic resistance and sensitivity pattern of Metallo-β-Lactamase Producing Gram-Negative Bacilli in ventilator-associated pneumonia in the intensive care unit of a public medical school hospital in Bangladesh. Hosp Pract (1995) 2020; 48:128-136. [PMID: 32271642 DOI: 10.1080/21548331.2020.1754687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICU), accounting for 25% of all ICU infections. Antimicrobial resistance is increasing and becoming a significant health problem worldwide, increasing hospital length of stay, mortality and costs. Identifying antibiotic resistance patterns in VAP is important as this can cause outbreaks in ICUs. To date, there have been limited studies assessing this in Bangladesh. Consequently, the primary objective of this research was to study the species of bacterial growth and to determine the antibiotic resistance patterns of Metallo-β-Lactamase (MBL) producing gram-negative bacilli among ICU patients with VAP in a public medical school hospital, Bangladesh. In addition, identify the factors associated with a positive culture to provide future guidance. METHOD Cross-sectional study performed in the Chattogram Medical College Hospital, Bangladesh. Mueller Hinton agar plates were used for antibiotic sensitivity testing by the Kirby-Buer disc diffusion test. RESULTS Among 105 clinically suspected VAP cases, qualitative cultures were positive in 95 (90%) of them. The most common bacteria identified were Acinetobacter spp. (43.2%), Klebsiella spp. (20%) and Pseudomonas spp. (18.9%). A positive culture was not associated with patients' age or gender. Among 41 isolated Acinetobacter spp., 38 (92.7%) were resistant to gentamicin followed by 36 (87.8%) to ceftriaxone. Among 24 isolated Klebsiella spp., 22 (83.3%) were resistant to ceftriaxone. Among 18 isolated Pseudomonas spp., 16 (88.8%) were resistant to ciprofloxacin, and 13 (72.2%) were resistant to ceftriaxone. Among nine isolated E. coli, all were resistant to ceftriaxone and ciprofloxacin. All four Proteus spp. (100%) isolated were resistant to ciprofloxacin. Additionally, phenotype MBL producing was 65.22% and genotype was 45.65% among imipenem resistant pathogens. Imipenem resistant pathogens were sensitive to amoxyclav, amikacin¸ azithromycin, ceftazidime, ceftriaxone, colistin and gentamycin. CONCLUSION A positive culture was detected in 90% of VAP patients, but it was not associated with the patients' age and gender. The most common bacteria identified were Acinetobacter spp., Klebsiella spp. and Pseudomonas spp., where the majority of these were resistant to ceftriaxone. The results are being used to provide future guidance on the empiric management of VAP in this hospital.
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Affiliation(s)
- Tanzina Nusrat
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nasima Akter
- Department of Microbiology, Chittagong Medical College , Panchlaish, Chattogram, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia , Bandar Indera Mahkota, Kuantan, Malaysia
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow, UK
- Department of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University , Pretoria, South Africa
- Health Economics Centre, University of Liverpool , Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm, Sweden
| | | | - Mainul Haque
- Faculty of Medicine and Defense Health, Universiti Pertahanan Nasional Malaysia (National Defense University of Malaysia) , Kem Sungai Besi, Kuala Lumpur, Malaysia
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Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1182-1192. [PMID: 32470329 DOI: 10.1016/s1473-3099(20)30084-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antibiotic prophylaxis is frequently continued for 1 day or more after surgery to prevent surgical site infection. Continuing antibiotic prophylaxis after an operation might have no advantage compared with its immediate discontinuation, and it unnecessarily exposes patients to risks associated with antibiotic use. In 2016, WHO recommended discontinuation of antibiotic prophylaxis after surgery. We aimed to update the evidence that formed the basis for that recommendation. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, CINAHL, CENTRAL, and WHO regional medical databases for randomised controlled trials (RCTs) on postoperative antibiotic prophylaxis that were published from Jan 1, 1990, to July 24, 2018. RCTs comparing the effect of postoperative continuation versus discontinuation of antibiotic prophylaxis on the incidence of surgical site infection in patients undergoing any surgical procedure with an indication for antibiotic prophylaxis were eligible. The primary outcome was the effect of postoperative surgical antibiotic prophylaxis continuation versus its immediate discontinuation on the occurrence of surgical site infection, with a prespecified subgroup analysis for studies that did and did not adhere to current best practice standards for surgical antibiotic prophylaxis. We calculated summary relative risks (RRs) with corresponding 95% CIs using a random effects model (DerSimonian and Laird). We evaluated heterogeneity with the χ2 test, I2, and τ2, and visually assesed publication bias with a contour-enhanced funnel plot. This study is registered with PROSPERO, CRD42017060829. FINDINGS We identified 83 relevant RCTs, of which 52 RCTs with 19 273 participants were included in the primary meta-analysis. The pooled RR of surgical site infection with postoperative continuation of antibiotic prophylaxis versus its immediate discontinuation was 0·89 (95% CI 0·79-1·00), with low heterogeneity in effect size between studies (τ2=0·001, χ2 p=0·46, I2=0·7%). Our prespecified subgroup analysis showed a significant association between the effect estimate and adherence to best practice standards of surgical antibiotic prophylaxis: the RR of surgical site infection was reduced with continued antibiotic prophylaxis after surgery compared with its immediate discontinuation in trials that did not meet best practice standards (0·79 [95% CI 0·67-0·94]) but not in trials that did (1·04 [0·85-1·27]; p=0·048). Whether studies adhered to best practice standards explained all variance in the pooled estimate from the primary meta-analysis. INTERPRETATION Overall, we identified no conclusive evidence for a benefit of postoperative continuation of antibiotic prophylaxis over its discontinuation. When best practice standards were followed, postoperative continuation of antibiotic prophylaxis did not yield any additional benefit in reducing the incidence of surgical site infection. These findings support WHO recommendations against this practice. FUNDING None.
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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Nisabwe L, Brice H, Umuhire MC, Gwira O, Harelimana JDD, Nzeyimana Z, Sebatunzi OR, Rusingiza EK, Hahirwa I, Muvunyi CM. Knowledge and attitudes towards antibiotic use and resistance among undergraduate healthcare students at University of Rwanda. J Pharm Policy Pract 2020; 13:7. [PMID: 32337049 PMCID: PMC7175502 DOI: 10.1186/s40545-020-00207-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/31/2020] [Indexed: 12/03/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is an imminent threat to modern medicine. As the efficacy of treatment regimens is reduced, mortality and morbidity attributed to infectious diseases is expected to rise dramatically across the globe. Antimicrobial stewardship and good prescription practices are critical to conserving available therapeutics; it is appropriate, therefore, to appraise our attitudes and knowledge of antimicrobial resistance, particularly for the future healthcare practitioners. Methods This is a descriptive cross-sectional study that was conducted among 282 medicals, dental and pharmacy students from the University of Rwanda. Questionnaires were used to collect data from the 4th to 29th March 2017. Results Students from Level 3 to level 6 have demonstrated a good knowledge on antibiotics and antimicrobial resistance. Generally, 95% (n = 218) agreed that the inappropriate use of antibiotics could lead to antibiotic resistance. It was found that 96% (n = 220) of the respondents had heard about AMR outside their degree courses. 49% (n = 112) of the participants reported that they are able to purchase antibiotics without a prescription. 96% (n = 220) agreed that it was important for healthcare students to be knowledgeable about antimicrobial resistance. Perhaps most surprisingly, it was found that 83% (n = 191) of participants were unfamiliar with the concept of antimicrobial stewardship and 49% (n = 21) had not yet discussed antimicrobial resistance as part of their education, albeit only 1% (n = 3) was completely unfamiliar with the term. Furthermore, 38% (n = 86) did not support that the antibiotics were overused in Rwanda, 23% (n = 10) did not agree that inappropriate antimicrobial use contributed to antimicrobial resistance, and 50% (n = 22) of participants agreed that antibiotics were indicated in the treatment of pain and inflammation. Conclusions The present study reports a moderate knowledge on AMR among the healthcare students. The gaps in the current formal training of healthcare individuals have been identified as well. We highlight the necessity to enhance educational approaches to introduce the key concepts of AMR and antimicrobial stewardship to the curriculum of healthcare students.
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Affiliation(s)
- Lyduine Nisabwe
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Hirwa Brice
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Marie Christine Umuhire
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Olivia Gwira
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean De Dieu Harelimana
- 2Department of Biomedical Laboratory Science, School of Health Science, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Zephanie Nzeyimana
- Department of Medical Laboratory Sciences, Mount Kenya University, Kigali, Rwanda
| | - Osee Rurambya Sebatunzi
- 4Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and health Sciences, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Kamanzi Rusingiza
- 5Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and health Sciences, University of Rwanda, Kigali, Rwanda
| | - Innocent Hahirwa
- 1Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Claude Mambo Muvunyi
- 6Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Afriyie DK, Sefah IA, Sneddon J, Malcolm W, McKinney R, Cooper L, Kurdi A, Godman B, Seaton RA. Antimicrobial point prevalence surveys in two Ghanaian hospitals: opportunities for antimicrobial stewardship. JAC Antimicrob Resist 2020; 2:dlaa001. [PMID: 34222959 PMCID: PMC8210261 DOI: 10.1093/jacamr/dlaa001] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improved knowledge regarding antimicrobial use in Ghana is needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPSs) in hospitals. Objectives were to: (i) provide baseline data in two hospitals [Keta Municipal Hospital (KMH) and Ghana Police Hospital (GPH)] and identify priorities for improvement; (ii) assess the feasibility of conducting PPSs; and (iii) compare results with other studies. METHODS Standard PPS design using the Global PPS paper forms, subsequently transferred to their template. Training undertaken by the Scottish team. Quality indicators included: rationale for use; stop/review dates; and guideline compliance. RESULTS Prevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other β-lactam antibiotics were the most frequently prescribed in both hospitals, with third-generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously, duration was generally short with timely oral switching and infections were mainly community acquired. Encouragingly, there was good documentation of the indications for antibiotic use in both hospitals and 50.0%-66.7% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there were no missed doses. The duration of use for surgical prophylaxis was generally more than 1 day (69.0% in GPH and 77.0% in KMH). CONCLUSIONS These two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible, relatively rapid and achieved with limited training. Targets for improvement identified included reduction of broad-spectrum antibiotics and duration of treatment.
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Affiliation(s)
| | - Israel A Sefah
- Department of Pharmacy, Keta Municipal Hospital, Keta-Dzelukope, Volta Region, Ghana
| | - Jacqueline Sneddon
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - William Malcolm
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Rachel McKinney
- NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh, UK
| | - Lesley Cooper
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - R Andrew Seaton
- Queen Elizabeth University Hospital, Govan Road, Glasgow, UK
- University of Glasgow, Glasgow, UK
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Hayat K, Rosenthal M, Gillani AH, Chang J, Ji W, Yang C, Jiang M, Zhao M, Fang Y. Perspective of Key Healthcare Professionals on Antimicrobial Resistance and Stewardship Programs: A Multicenter Cross-Sectional Study From Pakistan. Front Pharmacol 2020; 10:1520. [PMID: 31998124 PMCID: PMC6967405 DOI: 10.3389/fphar.2019.01520] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is an increasing global threat, and hospital-based antimicrobial stewardship programs (ASPs) are one of the effective approaches to tackle AMR globally. This study was intended to determine the attitude of key healthcare professionals (HCPs), including physicians, nurses, and hospital pharmacists, towards AMR and hospital ASPs. Methods: A cross-sectional study design was used to collect data from HCPs employed in public teaching hospitals of Punjab, Pakistan, from January 2019 to March 2019. A cluster-stratified sampling method was applied. Descriptive statistics, Mann Whitney and Kruskal Wallis tests were used for analysis. Results: A response rate of 81.3% (881/1083) for the surveys was obtained. The majority of the physicians (247/410, 60.2%) perceived AMR to be a serious problem in Pakistani hospitals (p < 0.001). Most of the HCPs considered improving antimicrobial prescribing (580/881, 65.8%; p < 0.001) accompanied by the introduction of prospective audit with feedback (301/881, 75.8%; p < 0.001), formulary restriction (227/881, 57.2%; p = 0.004) and regular educational activities (300/881, 75.6%; p = 0.015) as effective ASP methods to implement hospital ASPs in Pakistan. A significant association was found between median AMR and ASP scores with age, years of experience, and types of HCPs (p < 0.05). Conclusions: The attitude of most of the HCPs was observed to be positive towards hospital-based ASPs regardless of their poor awareness about ASPs. The important strategies, including prospective audit with feedback and regular educational sessions proposed by HCPs, will support the initiation and development of local ASPs for Pakistani hospitals.
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Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Mississippi, MS, United States
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
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50
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Godman B. Ongoing initiatives to improve the prescribing of medicines across sectors and the implications. ADVANCES IN HUMAN BIOLOGY 2020. [DOI: 10.4103/aihb.aihb_90_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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