Antimicrobial point prevalence surveys in two Ghanaian hospitals: opportunities for antimicrobial stewardship.
Journal
JAC-antimicrobial resistance
ISSN: 2632-1823
Titre abrégé: JAC Antimicrob Resist
Pays: England
ID NLM: 101765283
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
17
10
2019
revised:
15
12
2019
accepted:
16
12
2019
entrez:
5
7
2021
pubmed:
18
2
2020
medline:
18
2
2020
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 34222959
doi: 10.1093/jacamr/dlaa001
pii: dlaa001
pmc: PMC8210261
doi:
Types de publication
Journal Article
Langues
eng
Pagination
dlaa001Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
Références
BMC Public Health. 2019 Jun 21;19(1):797
pubmed: 31226974
Lancet Infect Dis. 2014 Aug;14(8):742-750
pubmed: 25022435
Bull World Health Organ. 2016 Aug 1;94(8):558-558A
pubmed: 27516629
S Afr Med J. 2017 Aug 25;107(9):738-740
pubmed: 28875877
Lancet Glob Health. 2018 Jun;6(6):e619-e629
pubmed: 29681513
Infect Dis (Auckl). 2016 Jul 11;9:33-8
pubmed: 27429557
Ther Clin Risk Manag. 2016 Mar 12;12:413-26
pubmed: 27042083
Basic Clin Pharmacol Toxicol. 2014 Sep;115(3):268-76
pubmed: 24528496
Antimicrob Resist Infect Control. 2013 Jan 15;2(1):3
pubmed: 23320479
PLoS One. 2019 Jan 16;14(1):e0209847
pubmed: 30650099
Clin Infect Dis. 2004 Jun 15;38(12):1706-15
pubmed: 15227616
BMC Health Serv Res. 2018 Feb 20;18(1):126
pubmed: 29458432
Lancet. 2016 Jan 16;387(10015):285-95
pubmed: 26603921
Int J Environ Res Public Health. 2019 May 05;16(9):
pubmed: 31060262
Eur J Health Econ. 2019 Jun;20(4):483-485
pubmed: 30560434
Lancet. 2016 Jan 9;387(10014):e3-5
pubmed: 26603924
PLoS One. 2017 Dec 21;12(12):e0189621
pubmed: 29267306
J Hosp Infect. 2019 Jan;101(1):60-68
pubmed: 29730140
JAMA Intern Med. 2014 May;174(5):661-2
pubmed: 24595627
Lancet Infect Dis. 2016 Sep;16(9):1017-1025
pubmed: 27312577
Hosp Pract (1995). 2018 Aug;46(3):97-102
pubmed: 29521136
Expert Rev Anti Infect Ther. 2017 Jul;15(7):713-721
pubmed: 28425828
Ann Saudi Med. 2017 Sep-Oct;37(5):375-385
pubmed: 28988252
Proc Natl Acad Sci U S A. 2018 Apr 10;115(15):E3463-E3470
pubmed: 29581252
Hosp Pract (1995). 2017 Oct;45(4):143-149
pubmed: 28657382
Int J Qual Health Care. 2019 Jun 1;31(5):338-345
pubmed: 30169688
Antimicrob Resist Infect Control. 2019 Feb 12;8:35
pubmed: 30805182
Glob Heart. 2014 Sep;9(3):347-58
pubmed: 25667187
Lancet Infect Dis. 2018 Jan;18(1):18-20
pubmed: 29303731
Medicine (Baltimore). 2017 Jul;96(29):e6903
pubmed: 28723736
Clin Microbiol Infect. 2016 Oct;22(10):888.e1-888.e9
pubmed: 27432770
Heliyon. 2019 Jul 25;5(7):e02159
pubmed: 31384689
BMC Public Health. 2017 Nov 23;17(1):896
pubmed: 29169340
Hosp Pract (1995). 2018 Aug;46(3):128-136
pubmed: 29652559
Wellcome Open Res. 2017 Sep 26;2:92
pubmed: 29062918
Antimicrob Agents Chemother. 2007 Mar;51(3):864-7
pubmed: 17210766
Bull World Health Organ. 2018 Apr 01;96(4):266-280
pubmed: 29695883
J Public Health (Oxf). 2017 Mar 1;39(1):8-13
pubmed: 26944074
J Infect Public Health. 2019 Jan - Feb;12(1):77-82
pubmed: 30270148
Antibiotics (Basel). 2014 Sep 10;3(3):450-60
pubmed: 27025755
BMC Pharmacol Toxicol. 2014 May 19;15:26
pubmed: 24887310
J Antimicrob Chemother. 2018 Jun 1;73(suppl_6):vi40-vi49
pubmed: 29878218
Antimicrob Resist Infect Control. 2012 Feb 03;1(1):7
pubmed: 22958296
Pediatr Infect Dis J. 2019 Feb;38(2):122-126
pubmed: 29677085
J Glob Antimicrob Resist. 2019 Jun;17:132-136
pubmed: 30557686
Nat Rev Microbiol. 2019 Jan;17(1):3
pubmed: 30467331
Expert Rev Clin Pharmacol. 2017 Nov;10(11):1273-1280
pubmed: 28776442
Lancet. 2016 Jan 9;387(10014):168-75
pubmed: 26603918
BMC Infect Dis. 2014 Jan 09;14:13
pubmed: 24405683
Lancet Infect Dis. 2019 Jan;19(1):56-66
pubmed: 30409683
Hosp Pract (1995). 2019 Apr;47(2):88-95
pubmed: 30963821
PLoS Med. 2016 Mar 02;13(3):e1001974
pubmed: 26934098
Eur J Clin Microbiol Infect Dis. 2015 Aug;34(8):1631-7
pubmed: 26017664
Antimicrob Resist Infect Control. 2018 Jan 26;7:15
pubmed: 29423190
Expert Rev Pharmacoecon Outcomes Res. 2017 Feb;17(1):1-4
pubmed: 26954076
J Antimicrob Chemother. 2010 Sep;65(9):2028-36
pubmed: 20581121
J Chemother. 2019 Nov - Dec;31(7-8):378-387
pubmed: 31145043
Expert Rev Anti Infect Ther. 2019 Apr;17(4):285-293
pubmed: 30755077
Surg Infect (Larchmt). 2017 May/Jun;18(4):379-382
pubmed: 28541808
BMJ Open Qual. 2018 Jan 6;7(1):e000180
pubmed: 29333498
Lancet Infect Dis. 2018 Oct;18(10):1066-1067
pubmed: 30303099
Clin Microbiol Infect. 2017 Nov;23(11):812-818
pubmed: 28712667
Expert Rev Anti Infect Ther. 2019 Jul;17(7):535-546
pubmed: 31257952