Antimicrobial point prevalence surveys in two Ghanaian hospitals: opportunities for antimicrobial stewardship.
Antimicrobial point prevalence surveys in two Ghanaian hospitals: opportunities for antimicrobial stewardship.
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DOI：
10.1093/jacamr/dlaa001
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发表时间：
2020-03
影响因子：
3.4
通讯作者：
Seaton RA
中科院分区：
文献类型：
--
作者：
Afriyie DK;Sefah IA;Sneddon J;Malcolm W;McKinney R;Cooper L;Kurdi A;Godman B;Seaton RA
需要提高加纳抗菌药物使用的知识，以减少抗菌药物耐药性（AMR）。这包括医院的点患病率研究（PPS）。目标是：（i）提供两家医院[凯塔市立医院（KMH）和加纳警察医院（GPH）]的基线数据，并确定改进的优先事项;（ii）评估进行PPS的可行性;（iii）将结果与其他研究进行比较。标准PPS设计使用全球PPS纸质表格，随后转移到其模板。苏格兰队进行的训练。质量指标包括：使用依据;停止/审查日期;和指南合规性。抗生素使用率分别为65.0%和82.0%。青霉素类和其他β-内酰胺类抗生素是两家医院最常用的处方，第三代头孢菌素主要用于GPH。抗生素治疗主要是经验性的，通常静脉给药，持续时间通常较短，及时更换口服药物，感染主要是社区获得性的。令人鼓舞的是，两家医院都有良好的抗生素使用适应症记录，50.0%-66.7%的指南依从性（尽管许多适应症没有指南）。此外，几乎所有处方抗生素都有停药日期，没有漏服剂量。用于手术预防的持续时间通常超过1天（GPH为69.0%，KMH为77.0%）。这两家医院是加纳第一家使用全球PPS系统的医院。我们发现PPS是可行的，相对快速，并通过有限的培训实现。确定的改善目标包括减少广谱抗生素和治疗时间。
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.