Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned

Author:

Alabi Abraham S1,Picka Stephen W1,Sirleaf Reubvera1,Ntirenganya Pacifique R2,Ayebare Arnold2,Correa Nidia3,Anyango Sarah2,Ekwen Gerald2,Agu Emmanuel4,Cook Rebecca23,Yarngrorble John4,Sanoe Ibrahim4,Dugulu Henry4,Wiefue Emmanuel4,Gahn-Smith Diana4,Kateh Francis N4,Hallie Ezekiel F5,Sidonie Christiane G6,Aboderin Aaron O7,Vassellee David8,Bishop Damien8,Lohmann Daniel8,Naumann-Hustedt Manja1,Dörlemann Alois1,Schaumburg Frieder9

Affiliation:

1. Health Focus GmbH , Friedrich-Ebert-Straße 33 , 14469 Potsdam, Germany

2. Partners In Health , Sophie Road Oldest, Congo Town , Monrovia, Liberia

3. Partners In Health , Boston, MA , USA

4. Ministry of Health , Capitol Bye-Pass , Monrovia, Liberia

5. School of Pharmacy, University of Liberia , Monrovia , Liberia

6. Centre de Recherches Medicales, CERMEL , Lambarene , Gabon

7. Obafemi Awolowo University , Ile-Ife , Nigeria

8. German Corporation for International Cooperation, GIZ , Tubman Boulevard, Congo Town , Monrovia, Liberia

9. Institute of Medical Microbiology, University of Münster , Münster , Germany

Abstract

Abstract Background Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs). Objectives To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals. Methods A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use. Results The majority of patients had skin and soft tissue infections (n = 108) followed by surgical site infections (n = 72), pneumonia (n = 64), urinary tract infection (n = 48) and meningitis (n = 18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, P < 0.0005), dosage (from 15.2% to 36.5%, P < 0.0005) and duration (from 13.2% to 31.0%, P < 0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P < 0.0005). Conclusions AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.

Funder

Federal Ministry for Economic Cooperation and Development

Deutsche Gesellschaft für Internationale Zusammenarbeit

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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