1776. Establishing an Antimicrobial Stewardship Program in a Resource Limited Setting: Experience of an Ethiopian Hospital

BACKGROUND: Antimicrobial stewardship programs are nonexistent in most resource limited settings like Ethiopia. This has resulted in inappropriate use of antibiotics and widespread development of antibiotic resistance. Targeted initiatives surrounding antimicrobial use are needed to tackle this global health threat. Therefore, a program was established to generate data on antibiotic consumption, resistance, and facilitate appropriate use of antibiotics at an academic hospital in northwestern Ethiopia. METHODS: A committee was developed with a multidisciplinary team of clinicians, microbiologist, pharmacists and nurses. A baseline assessment of antibiotic use in the hospital was conducted through review of patient prescriptions and antibiotic inventory changes over time. To understand patterns, listed indication for use was recorded. Clinical audits, provider feedback mechanisms, and a quarterly antibiogram were also developed. RESULTS: Among 384 records of patients with infectious diseases, 250 adult and 134 pediatric cases were identified. Community acquired pneumonia (CAP) was the most common reason for use of antibiotics, accounting for 33.6% of adults and 22.2% of pediatric cases. Cephalosporins and penicillins were used in adults with CAP in 48.8% and 51.2% of cases, respectively, with or without macrolides or tetracycline. For severe CAP (30 cases), WHO or IDSA guideline concordance was identified as follows: appropriate antibiotic selection in 23 (76.6%), appropriate treatment duration in 15 (50.0%), and timely switch to oral therapy in 20 (66.7%) of the cases. The quarterly antibiogram included 516 bacterial isolates over one year. The most common organisms were Staphylococcus aureus and Escherichia coli, accounting for 34.7% and 16.8% isolates, respectively. The challenges faced in establishing the program were lack of electronic medical records for tracking antibiotic use and inconsistent supply of microbiologic reagents for microbial surveillance. CONCLUSION: An effective antimicrobial stewardship program can be established in a resource limited setting with a committed team. Data generated by the program will be used to guide appropriate use of antibiotics and design interventions. DISCLOSURES: All authors: No reported disclosures.