Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment.
Strengthening Antimicrobial Resistance Diagnostic Capacity in Rural Rwanda: A Feasibility Assessment.
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DOI：
10.5334/aogh.3416
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发表时间：
2021
影响因子：
2.9
通讯作者：
Kateera F
中科院分区：
文献类型：
--
作者：
Umutesi G;Velin L;Muwanguzi M;Faktor K;Mugabo C;Rukundo G;Rucogoza A;Yankurije M;Mazimpaka C;de Dieu Gatete J;Shyirambere C;Hedt-Gauthier B;Riviello R;Mpunga T;Mwikarago EI;Kateera F
抗生素耐药性（AMR）是一个全球性的公共卫生威胁。更糟糕的是，低收入和中等收入国家缺乏合理使用抗生素的数据。评估建立抗生素耐药性检测微生物学能力的可行性，并估算在卢旺达农村地区医院建立微生物学检测能力的成本。进行了实验室需求评估，并根据查明的设备差距，处理了适当的技术援助。对实验室技术人员进行了微生物检测流程培训，并在地区医院（DH）实验室收集和培养开放性伤口样本，然后将其运送到国家参考实验室（NRL）进行细菌鉴定和抗生素敏感性检测。在DH和NRL进行质量控制（QC）评估。然后，我们估计了实施分散式微生物学诊断测试系统的三种方案的成本。由于该区域没有适当的用品和设备，从完成实验室需求评估到开始样本收集工作，延迟了8个月。当比较研究实验室技术人员处理的研究样本和其他实验室工作人员处理的QC样本时，在DH检测的样本的检测结果一致性为85.0%，在NRL检测的一致性为90.0%。三名地区卫生员的基本设备和用品费用为245 871美元。处理600个样本的估计费用从29 500美元到92 590美元不等。在农村卫生保健机构进行基本微生物化验所需的设备和供应方面存在重大差距。尽管存在这些挑战，我们证明了在卢旺达卫生署建立微生物检测能力是可行的。建立微生物检测能力对于改善临床护理，告知合理的抗生素使用至关重要，并最终有助于在卢旺达农村和类似环境中建立强大的国家抗菌药物管理计划。
Antimicrobial resistance (AMR) is a global public health threat. Worse still, there is a paucity of data from low- and middle-income countries to inform rational antibiotic use. Assess the feasibility of setting up microbiology capacity for AMR testing and estimate the cost of setting up microbiology testing capacity at rural district hospitals in Rwanda. Laboratory needs assessments were conducted, and based on identified equipment gaps, appropriate requisitions were processed. Laboratory technicians were trained on microbiology testing processes and open wound samples were collected and cultured at the district hospital (DH) laboratories before being transported to the National Reference Laboratory (NRL) for bacterial identification and antibiotic susceptibility testing. Quality control (QC) assessments were performed at the DHs and NRL. We then estimated the cost of three scenarios for implementing a decentralized microbiology diagnostic testing system. There was an eight-month delay from the completion of the laboratory needs assessments to the initiation of sample collection due to the regional unavailability of appropriate supplies and equipment. When comparing study samples processed by study laboratory technicians and QC samples processed by other laboratory staff, there was 85.0% test result concordance for samples testing at the DHs and 90.0% concordance at the NRL. The cost for essential equipment and supplies for the three DHs was $245,871. The estimated costs for processing 600 samples ranged from $29,500 to $92,590. There are major gaps in equipment and supply availability needed to conduct basic microbiology assays at rural DHs. Despite these challenges, we demonstrated that it is feasible to establish microbiological testing capacity in Rwandan DHs. Building microbiological testing capacity is essential for improving clinical care, informing rational antibiotics use, and ultimately, contributing to the establishment of robust national antimicrobial stewardship programs in rural Rwanda and comparable settings.