Cargando…

Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing

BACKGROUND: Antimicrobial resistance threatens human health worldwide. Antimicrobial misuse is a major driver of resistance. Promoting appropriate antimicrobial use requires an understanding of how clinical microbiology services are utilized, particularly in resource-limited settings. OBJECTIVES: To...

Descripción completa

Detalles Bibliográficos
Autores principales: Fox-Lewis, Shivani, Pol, Sreymom, Miliya, Thyl, Day, Nicholas P J, Turner, Paul, Turner, Claudia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890681/
https://www.ncbi.nlm.nih.gov/pubmed/29186330
http://dx.doi.org/10.1093/jac/dkx414
_version_ 1783312907652562944
author Fox-Lewis, Shivani
Pol, Sreymom
Miliya, Thyl
Day, Nicholas P J
Turner, Paul
Turner, Claudia
author_facet Fox-Lewis, Shivani
Pol, Sreymom
Miliya, Thyl
Day, Nicholas P J
Turner, Paul
Turner, Claudia
author_sort Fox-Lewis, Shivani
collection PubMed
description BACKGROUND: Antimicrobial resistance threatens human health worldwide. Antimicrobial misuse is a major driver of resistance. Promoting appropriate antimicrobial use requires an understanding of how clinical microbiology services are utilized, particularly in resource-limited settings. OBJECTIVES: To assess the appropriateness of antimicrobial prescribing and the factors affecting utilization of the established clinical microbiology service (CMS). The CMS comprises the microbiology laboratory, clinical microbiologists (infection doctors) and antimicrobial treatment guidelines. METHODS: This mixed-methods study was conducted at a non-governmental Cambodian paediatric hospital. Empirical and post-culture antimicrobial prescriptions were reviewed from medical records. The random sample included 10 outpatients per week in 2016 (retrospective) and 20 inpatients per week for 4 weeks in the medical, neonatal and intensive care wards (prospective). Post-culture prescriptions were assessed in patients with positive blood and cerebrospinal fluid cultures from 1 January 2014 to 31 December 2016. Focus group discussions and semi-structured interviews with clinicians explored barriers and facilitators to use of the CMS. RESULTS: Only 31% of outpatients were prescribed empirical antimicrobials. Post-culture prescriptions (394/443, 89%) were more likely to be appropriate than empirical prescriptions (447/535, 84%), based on treatment guidelines, microbiology advice and antimicrobial susceptibility test results (P = 0.015). Being comprehensive, accessible and trusted enabled CMS utilization. Clinical microbiologists provided a crucial human interface between the CMS and physicians. The main barriers were a strong clinical hierarchy and occasional communication difficulties. CONCLUSIONS: Antimicrobial prescribing in this hospital was largely appropriate. A culturally appropriate human interface linking the laboratory and physicians is essential in providing effective microbiology services and ensuring appropriate antimicrobial prescribing in resource-limited settings.
format Online
Article
Text
id pubmed-5890681
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-58906812018-04-13 Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing Fox-Lewis, Shivani Pol, Sreymom Miliya, Thyl Day, Nicholas P J Turner, Paul Turner, Claudia J Antimicrob Chemother Original Research BACKGROUND: Antimicrobial resistance threatens human health worldwide. Antimicrobial misuse is a major driver of resistance. Promoting appropriate antimicrobial use requires an understanding of how clinical microbiology services are utilized, particularly in resource-limited settings. OBJECTIVES: To assess the appropriateness of antimicrobial prescribing and the factors affecting utilization of the established clinical microbiology service (CMS). The CMS comprises the microbiology laboratory, clinical microbiologists (infection doctors) and antimicrobial treatment guidelines. METHODS: This mixed-methods study was conducted at a non-governmental Cambodian paediatric hospital. Empirical and post-culture antimicrobial prescriptions were reviewed from medical records. The random sample included 10 outpatients per week in 2016 (retrospective) and 20 inpatients per week for 4 weeks in the medical, neonatal and intensive care wards (prospective). Post-culture prescriptions were assessed in patients with positive blood and cerebrospinal fluid cultures from 1 January 2014 to 31 December 2016. Focus group discussions and semi-structured interviews with clinicians explored barriers and facilitators to use of the CMS. RESULTS: Only 31% of outpatients were prescribed empirical antimicrobials. Post-culture prescriptions (394/443, 89%) were more likely to be appropriate than empirical prescriptions (447/535, 84%), based on treatment guidelines, microbiology advice and antimicrobial susceptibility test results (P = 0.015). Being comprehensive, accessible and trusted enabled CMS utilization. Clinical microbiologists provided a crucial human interface between the CMS and physicians. The main barriers were a strong clinical hierarchy and occasional communication difficulties. CONCLUSIONS: Antimicrobial prescribing in this hospital was largely appropriate. A culturally appropriate human interface linking the laboratory and physicians is essential in providing effective microbiology services and ensuring appropriate antimicrobial prescribing in resource-limited settings. Oxford University Press 2018-02 2017-11-24 /pmc/articles/PMC5890681/ /pubmed/29186330 http://dx.doi.org/10.1093/jac/dkx414 Text en © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Research
Fox-Lewis, Shivani
Pol, Sreymom
Miliya, Thyl
Day, Nicholas P J
Turner, Paul
Turner, Claudia
Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
title Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
title_full Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
title_fullStr Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
title_full_unstemmed Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
title_short Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
title_sort utilization of a clinical microbiology service at a cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890681/
https://www.ncbi.nlm.nih.gov/pubmed/29186330
http://dx.doi.org/10.1093/jac/dkx414
work_keys_str_mv AT foxlewisshivani utilizationofaclinicalmicrobiologyserviceatacambodianpaediatrichospitalanditsimpactonappropriateantimicrobialprescribing
AT polsreymom utilizationofaclinicalmicrobiologyserviceatacambodianpaediatrichospitalanditsimpactonappropriateantimicrobialprescribing
AT miliyathyl utilizationofaclinicalmicrobiologyserviceatacambodianpaediatrichospitalanditsimpactonappropriateantimicrobialprescribing
AT daynicholaspj utilizationofaclinicalmicrobiologyserviceatacambodianpaediatrichospitalanditsimpactonappropriateantimicrobialprescribing
AT turnerpaul utilizationofaclinicalmicrobiologyserviceatacambodianpaediatrichospitalanditsimpactonappropriateantimicrobialprescribing
AT turnerclaudia utilizationofaclinicalmicrobiologyserviceatacambodianpaediatrichospitalanditsimpactonappropriateantimicrobialprescribing