Antibiotic use in Kenyan public hospitals: Prevalence, appropriateness and link to guideline availability.
Antibiotic use in Kenyan public hospitals: Prevalence, appropriateness and link to guideline availability.
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DOI：
10.1016/j.ijid.2020.07.084
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Tosas-Auguet O
中科院分区：
文献类型：
--
作者：
Maina M;Mwaniki P;Odira E;Kiko N;McKnight J;Schultsz C;English M;Tosas-Auguet O
我们报告了14家肯尼亚公立医院的点患病率调查结果。大约一半的住院患者接受了适当的抗生素治疗。实验室调查支持的抗生素处方不到1%。治疗指南的实际可用性影响治疗的适当性。有必要制定针对具体情况的、最新的、可获取的治疗指南。检查处方模式，探索指导方针在多大程度上是可用的，以及它们如何影响肯尼亚医院住院患者的治疗适当性。从肯尼亚14家公立医院的住院患者收集了抗微生物药物使用数据。对于每种处方，都是根据现有的当地和国际治疗准则，并通过与当地医学专家达成共识，确定治疗的适当性。采用单变量和多元回归分析探讨适当治疗、指南可得性和其他可能的解释因素之间的关系。3590名住院患者中有1675人（46.7%）使用抗菌素，3363张抗菌素处方中有3145人（94%）使用抗生素。两名患者（0.1%）接受了基于现有抗生素敏感性试验的治疗。对1502例单一诊断的患者进行了适当的治疗评估。其中805例（53.6%）接受了适当的治疗。物理治疗指南的可获得性增加了接受适当治疗的几率（优势比6.44[95% CI 4.81-8.64]）。适当的抗生素处方仍然是肯尼亚公立医院面临的一个挑战。这可以通过在所有部门提供针对具体情况的、最新的、易于获取的治疗指南以及提供更好的诊断支持来改善。
We report findings from a point prevalence survey across 14 Kenyan public hospitals. About half of the hospitalised patients received appropriate antibiotic therapy. Laboratory investigations supported less than 1% of the antibiotic prescriptions. Physical availability of treatment guidelines influenced treatment appropriateness. There is need for context-specific, up-to-date, and accessible treatment guidelines. To examine prescription patterns and explore to what extent guidelines are available and how they might influence treatment appropriateness among hospitalised patients in Kenyan hospitals. Data on antimicrobial usage were collected from hospitalised patients across 14 Kenyan public hospitals. For each prescription, appropriateness of treatment was defined using available local and international treatment guidelines and through consensus with local medical specialists. Association between appropriate treatment, guideline availability and other possible explanatory factors was explored using univariate and multiple regression analysis. There were 1675 (46.7%) of the 3590 hospitalised patients on antimicrobials with 3145(94%) of the 3363 antimicrobial prescriptions being antibiotics. Two patients (0.1%), had treatment based on available antibiotic susceptibility tests. Appropriate treatment was assessed in 1502 patients who had a single diagnosis. Of these, 805 (53.6%) received appropriate treatment. Physical availability of treatment guidelines increased the odds of receiving appropriate treatment Odds Ratio 6.44[95% CI 4.81–8.64]. Appropriate antibiotic prescription remains a challenge in Kenyan public hospitals. This may be improved by the availability of context-specific, up-to-date, and readily accessible treatment guidelines across all the departments, and by providing better diagnostic support.
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影响因子：
5.2
作者：
Irimu G;Wamae A;Wasunna A;Were F;Ntoburi S;Opiyo N;Ayieko P;Peshu N;English M
通讯作者：
English M
影响因子：
5.5
作者：
Ahoyo TA;Bankolé HS;Adéoti FM;Gbohoun AA;Assavèdo S;Amoussou-Guénou M;Kindé-Gazard DA;Pittet D
通讯作者：
Pittet D
影响因子：
--
作者：
Chukwuani, CM;Onifade, M;Sumonu, K
通讯作者：
Sumonu, K
影响因子：
2.9
作者：
Gharbi, Myriam;Doerholt, Katja;Sharland, Mike
通讯作者：
Sharland, Mike
影响因子：
3.7
作者：
Elbireer, Ali M.;Jackson, J. Brooks;Amukele, Timothy K.
通讯作者：
Amukele, Timothy K.