Opportunities and barriers to implementing antibiotic stewardship in low and middle-income countries: Lessons from a mixed-methods study in a tertiary care hospital in Ethiopia
Opportunities and barriers to implementing antibiotic stewardship in low and middle-income countries: Lessons from a mixed-methods study in a tertiary care hospital in Ethiopia
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DOI：
10.1371/journal.pone.0208447
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发表时间：
2018-12-20
期刊：
影响因子：
3.7
通讯作者：
Semret, Makeda
中科院分区：
文献类型：
--
作者：
Gebretekle, Gebremedhin Beedemariam;Mariam, Damen Haile;Semret, Makeda
背景解决抗菌素耐药性 (AMR) 的全球行动计划包括实施抗菌素管理 (AMS)，但很少有研究直接解决低收入和中等收入国家 (LMIC) 面临的挑战。我们的目的是探索医疗保健提供者对 AMR 的了解和看法，以及在埃塞俄比亚转诊医院成功实施药剂师主导的 AMS 干预的障碍/促进因素。方法Tikur Anbessa 专科医院 (TASH) 是亚的斯亚贝巴的一家拥有 800 个床位的三级中心，也是一项正在进行的为期 4 年的 AMR 研究的地点。 2017 年 5 月至 7 月期间，我们采用定量和定性混合的方法，使用预先测试的问卷和对有意选择的受访者进行半结构化访谈，对药剂师和医生进行了横断面调查，直至主题饱和。我们使用 X 2 和 Fisher 精确检验分析了医生和药剂师之间一致性比例的差异。定性数据按主题进行分析。 结果 共有 406 名调查受访者（358 名医生、48 名药剂师）和 35 名关键信息提供者（21 名医生和 14 名药剂师）入组。大多数调查受访者 (>90%) 强烈同意有关 AMR 的全球范围、管理、监测和教育的必要性的陈述，但他们对 AMR 影响因素的看法以及对常见细菌的机构耐药性概况的了解不太统一。近 60% 的受访者表示，很大一部分金黄色葡萄球菌感染是由耐甲氧西林菌株引起的（错误的说法），而只有 48% 的人认为很大一部分革兰氏阴性菌感染是由头孢菌素耐药菌株引起的（正确的说法）。医生和药剂师之间存在差异：更多药剂师同意广谱抗生素的使用与抗菌素耐药性之间的联系（p
BackgroundGlobal action plans to tackle antimicrobial resistance (AMR) include implementation of antimicrobial stewardship (AMS), but few studies have directly addressed the challenges faced by low and middle-income countries (LMICs). Our aim was to explore healthcare providers' knowledge and perceptions on AMR, and barriers/facilitators to successful implementation of a pharmacist-led AMS intervention in a referral hospital in Ethiopia.MethodsTikur Anbessa Specialized Hospital (TASH) is an 800-bed tertiary center in Addis Ababa, and the site of an ongoing 4-year study on AMR. Between May and July 2017, using a mixed approach of quantitative and qualitative methods, we performed a cross-sectional survey of pharmacists and physicians using a pre-tested questionnaire and semi-structured interviews of purposively selected respondents until thematic saturation. We analyzed differences in proportions of agreement between physicians and pharmacists using X 2 and fisher exact tests. Qualitative data was analyzed thematically.FindingsA total of 406 survey respondents (358 physicians, 48 pharmacists), and 35 key informants (21 physicians and 14 pharmacists) were enrolled. The majority of survey respondents (>90%) strongly agreed with statements regarding the global scope of AMR, the need for stewardship, surveillance and education, but their perceptions on factors contributing to AMR and their knowledge of institutional resistance profiles for common bacteria were less uniform. Close to 60% stated that a significant proportion of S. aureus infections were caused by methicillin-resistant strains (an incorrect statement), while only 48% thought a large proportion of gram-negative infections were caused by cephalosporin-resistant strains (a true statement). Differences were noted between physicians and pharmacists: more pharmacists agreed with statements on links between use of broad-spectrum antibiotics and AMR (p