Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries.
Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries.
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DOI：
10.3389/fpubh.2022.848802
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发表时间：
2022
影响因子：
5.2
通讯作者：
Tillekeratne, L. Gayani
中科院分区：
文献类型：
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作者：
Muro, Florida J.;Lyamuya, Furaha S.;Kwobah, Charles;Bollinger, John;Bodinayake, Champica K.;Nagahawatte, Ajith;Piyasiri, Bhagya;Kurukulasooriya, Ruvini;Ali, Shamim;Mallya, Rose;Rolfe, Robert;Ruwanpathirana, Anushka;Sheng, Tianchen;ostbye, Truls;Drew, Richard;Kussin, Peter;Woods, Christopher W.;Anderson, Deverick J.;Mmbaga, Blandina T.;Tillekeratne, L. Gayani
关键词：
要为低收入和中等收入国家(LMIC)制定有效的抗菌药物管理计划(ASP)，重要的是确定改善抗菌药物使用的关键目标。我们试图系统地描述三家LMIC医院的抗菌药使用情况和模式。2018-2019年，坦桑尼亚、肯尼亚和斯里兰卡的三家三级护理医院的成人内科病房连续入院患者。审查了病历的临床信息，包括开出的抗菌药的类型和持续时间，抗菌剂的使用适应症，以及下令进行的微生物检测。在研究期间，共有3149名患者入选：1,103名来自坦桑尼亚，750名来自肯尼亚，1,296名来自斯里兰卡。大多数患者为男性(1,783人，占总数的56.6%)，平均年龄为55岁(IQR 38-68)。在登记的患者中，1573人(50.0%)在住院期间接受了抗菌药治疗：坦桑尼亚为35.4%，肯尼亚为56.5%，斯里兰卡为58.6%。在每个部位，最常见的抗菌药物使用指征是下呼吸道感染(LRTI；40.2%)。然而，61.0%的患者在胸部X线片上没有LRTI征象的情况下接受了抗菌药治疗。在接受抗菌药物治疗的患者中，指导抗菌药物使用的工具未得到充分利用：12.0%的患者进行微生物培养，6.5%的患者进行微生物咨询。在三个LMIC地点的三级护理医院的相当大比例的患者中使用了抗菌素。未来的ASP努力应该包括改进LRTI的诊断和治疗，开发抗生素图谱来指导经验性抗菌药物的使用，以及增加微生物学测试的使用。
To develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and patterns of antimicrobial use in three LMIC hospitals. Consecutive patients admitted to the adult medical wards in three tertiary care hospitals in Tanzania, Kenya, and Sri Lanka were enrolled in 2018–2019. The medical record was reviewed for clinical information including type and duration of antimicrobials prescribed, indications for antimicrobial use, and microbiologic testing ordered. A total of 3,149 patients were enrolled during the study period: 1,103 from Tanzania, 750 from Kenya, and 1,296 from Sri Lanka. The majority of patients were male (1,783, 56.6% overall) with a median age of 55 years (IQR 38–68). Of enrolled patients, 1,573 (50.0%) received antimicrobials during their hospital stay: 35.4% in Tanzania, 56.5% in Kenya, and 58.6% in Sri Lanka. At each site, the most common indication for antimicrobial use was lower respiratory tract infection (LRTI; 40.2%). However, 61.0% received antimicrobials for LRTI in the absence of LRTI signs on chest radiography. Among patients receiving antimicrobials, tools to guide antimicrobial use were under-utilized: microbiologic cultures in 12.0% and microbiology consultation in 6.5%. Antimicrobials were used in a substantial proportion of patients at tertiary care hospitals across three LMIC sites. Future ASP efforts should include improving LRTI diagnosis and treatment, developing antibiograms to direct empiric antimicrobial use, and increasing use of microbiologic tests.
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DOI：
10.1016/j.ijid.2020.07.084
发表时间：
2020-10
期刊：
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
影响因子：
--
作者：
Maina M;Mwaniki P;Odira E;Kiko N;McKnight J;Schultsz C;English M;Tosas-Auguet O
通讯作者：
Tosas-Auguet O
坦桑尼亚六家推荐医院的抗菌使用：观点患病率调查。
影响因子：
2.9
作者：
Seni J;Mapunjo SG;Wittenauer R;Valimba R;Stergachis A;Werth BJ;Saitoti S;Mhadu NH;Lusaya E;Konduri N
通讯作者：
Konduri N
影响因子：
120.7
作者：
Gerber, Jeffrey S.;Prasad, Priya A.;Zaoutis, Theoklis E.
通讯作者：
Zaoutis, Theoklis E.
影响因子：
34.3
作者：
Versporten, Ann;Zarb, Peter;Goossens, Herman
通讯作者：
Goossens, Herman
影响因子：
5.2
作者：
Brink, Adrian J.;Messina, Angeliki P.;van den Bergh, Dena
通讯作者：
van den Bergh, Dena