Antibiotic prescribing patterns at a leading referral hospital in Kenya: A point prevalence survey
Antibiotic prescribing patterns at a leading referral hospital in Kenya: A point prevalence survey
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DOI：
10.4103/jrpp.jrpp_18_68
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发表时间：
2019-07-01
影响因子：
1
通讯作者：
Godman, Brian
中科院分区：
文献类型：
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作者：
Momanyi, Lydia;Opanga, Sylvia;Godman, Brian
目的：抗生素是必不可少的，使用不当会导致抗菌素耐药性（AMR）。目前，人们对肯尼亚医院中抗生素的使用情况知之甚少，作为最近解决抗菌素耐药性上升问题的国家行动计划的一部分，这一问题至关重要。因此，我们的目标是克服肯尼亚领先转诊医院的这一差距。研究结果随后将用于为这家医院和肯尼亚其他医院制定质量改进计划。方法：这是一项点患病率调查。药房团队从患者病历中提取抗生素使用数据。调查结果：抗生素处方的流行率为 54.7%，在重症监护病房和隔离病房中最高。大多数抗生素用于治疗（75.4%）而不是预防（29.0%）。大多数接受手术预防的患者持续时间较长（> 1 天），根据现行指南，只有 9.6% 的患者接受单剂量治疗。青霉素类（46.9%）是最常用的抗生素类别，其次是头孢菌素类（44.7%）。仅 37.3% 的病例记录了使用抗生素的指征。一般处方占 62.5%，经验处方占 82.6%。指南符合率为 45.8%。结论：确定了几个需要改进的领域，包括解决预防持续时间延长、广谱抗生素广泛处方、经验性处方率高以及缺乏抗菌药物适应证记录等问题。正在采取措施解决这一问题，其中药剂师发挥着关键作用。
Objective: Antibiotics are essential with inappropriate use leading to antimicrobial resistance (AMR). Currently, little is known about antibiotic use among hospitals in Kenya, which is essential to tackle as part of the recent national action plan addressing rising AMR rates. Consequently, the objective was to overcome this gap in a leading referral hospital in Kenya. The findings will subsequently be used to develop quality improvement programs for this and other hospitals in Kenya. Methods: This was a point prevalence survey. Data on antibiotic use were abstracted from patient medical records by a pharmacy team. Findings: The prevalence of antibiotic prescribing was 54.7%, highest in the intensive care unit and isolation wards. Most antibiotics were for treatment (75.4%) rather than prophylaxis (29.0%). The majority of patients on surgical prophylaxis were on prolonged duration (>1 day), with only 9.6% on a single dose as per current guidelines. Penicillins (46.9%) followed by cephalosporins (44.7%) were the most prescribed antibiotic classes. The indication for antibiotic use was documented in only 37.3% of encounters. Generic prescribing was 62.5% and empiric prescribing was seen in 82.6% of encounters. Guideline compliance was 45.8%. Conclusion: Several areas for improvement were identified including addressing prolonged duration for prophylaxis, extensive prescribing of broad-spectrum antibiotics, high rates of empiric prescribing, and lack of documenting the indication for antimicrobials. Initiatives are ongoing to address this with pharmacists playing a key role.