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2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal

BACKGROUND: Data surrounding antibiotic stewardship (AMS) in burn and chronic wound centers in low- and middle-income countries (LMIC) are limited. Given the long-term nature of the wounds, increased risk of infection and the potential for further infections being treated with antibiotics, burn and...

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Autores principales: Nauriyal, Varidhi, Dhoj. Joshi, Rajesh, Raj Poudel, Suresh, Banstola, Laxman, Joshi, Anip, Acharya, Arjun, Bahadur Thapa, Buddhi, Shrestha, Basudha, Maki, Gina, Shakya, Malika, Man. Joshi, Nilesh, Karki, Kshitij, Bajracharya, Deepak, Gudipati, Smitha, Zervos, Marcus, Kaljee, Linda, Prentiss, Tyler, Rai, Shankar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808960/
http://dx.doi.org/10.1093/ofid/ofz360.1719
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author Nauriyal, Varidhi
Dhoj. Joshi, Rajesh
Raj Poudel, Suresh
Banstola, Laxman
Joshi, Anip
Acharya, Arjun
Bahadur Thapa, Buddhi
Shrestha, Basudha
Maki, Gina
Shakya, Malika
Man. Joshi, Nilesh
Karki, Kshitij
Bajracharya, Deepak
Gudipati, Smitha
Zervos, Marcus
Kaljee, Linda
Prentiss, Tyler
Rai, Shankar
author_facet Nauriyal, Varidhi
Dhoj. Joshi, Rajesh
Raj Poudel, Suresh
Banstola, Laxman
Joshi, Anip
Acharya, Arjun
Bahadur Thapa, Buddhi
Shrestha, Basudha
Maki, Gina
Shakya, Malika
Man. Joshi, Nilesh
Karki, Kshitij
Bajracharya, Deepak
Gudipati, Smitha
Zervos, Marcus
Kaljee, Linda
Prentiss, Tyler
Rai, Shankar
author_sort Nauriyal, Varidhi
collection PubMed
description BACKGROUND: Data surrounding antibiotic stewardship (AMS) in burn and chronic wound centers in low- and middle-income countries (LMIC) are limited. Given the long-term nature of the wounds, increased risk of infection and the potential for further infections being treated with antibiotics, burn and chronic wound centers represent a unique opportunity for antimicrobial stewardship. METHODS: Three hospitals that maintain long-term burn or chronic wound wards were selected in two regions in Nepal. A post-prescription review and feedback program (PPRF) was instituted in these departments, and locally salient antibiotic practice guidelines were developed based on international and local standards by the research team and local experts. Chosen physicians at each facility were trained as master physician champions. Champions subsequently trained physicians in their wards and ensured that guidelines were followed by prescribing physicians. Baseline and post-intervention phases covered 5 months each during 2018–2019. During the post-intervention phase, physician champions reviewed antimicrobial use at 72 hours and made one of the three recommendations if the antibiotic course was deemed unjustified: changing the antibiotic, stopping the antibiotic course, or de-escalation of the antibiotic. RESULTS: 482 patients were enrolled throughout the duration of the study, with 241 patients in each of the baseline and post-intervention periods. The average length of stay was 8.0 days in baseline (range 3–48 days) vs. 6.4 days (range 3–70 days) during post-intervention. Between baseline and post-intervention, IV antibiotics decreased from 1,161 antibiotic-days per 1,000 patient-days (PD/1,000) to 1,137 PD/1,000. Oral antibiotics decreased from 101 PD/1,000 to 77 PD/1,000. In addition, cephalosporins decreased from 526 PD/1,000 to 474 PD/1,000, and aminoglycosides decreased from 264 PD/1,000 to 117 PD/1,000. CONCLUSION: Appropriate antimicrobial use is vital in patients with a long length of stays in the hospital to reduce the development of multi-drug-resistant organisms. This intervention showed that a post-prescription review and feedback model can have impact in chronic wound and burn centers in Nepal and be further adapted for use in other LMIC. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-68089602019-10-28 2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal Nauriyal, Varidhi Dhoj. Joshi, Rajesh Raj Poudel, Suresh Banstola, Laxman Joshi, Anip Acharya, Arjun Bahadur Thapa, Buddhi Shrestha, Basudha Maki, Gina Shakya, Malika Man. Joshi, Nilesh Karki, Kshitij Bajracharya, Deepak Gudipati, Smitha Zervos, Marcus Kaljee, Linda Prentiss, Tyler Rai, Shankar Open Forum Infect Dis Abstracts BACKGROUND: Data surrounding antibiotic stewardship (AMS) in burn and chronic wound centers in low- and middle-income countries (LMIC) are limited. Given the long-term nature of the wounds, increased risk of infection and the potential for further infections being treated with antibiotics, burn and chronic wound centers represent a unique opportunity for antimicrobial stewardship. METHODS: Three hospitals that maintain long-term burn or chronic wound wards were selected in two regions in Nepal. A post-prescription review and feedback program (PPRF) was instituted in these departments, and locally salient antibiotic practice guidelines were developed based on international and local standards by the research team and local experts. Chosen physicians at each facility were trained as master physician champions. Champions subsequently trained physicians in their wards and ensured that guidelines were followed by prescribing physicians. Baseline and post-intervention phases covered 5 months each during 2018–2019. During the post-intervention phase, physician champions reviewed antimicrobial use at 72 hours and made one of the three recommendations if the antibiotic course was deemed unjustified: changing the antibiotic, stopping the antibiotic course, or de-escalation of the antibiotic. RESULTS: 482 patients were enrolled throughout the duration of the study, with 241 patients in each of the baseline and post-intervention periods. The average length of stay was 8.0 days in baseline (range 3–48 days) vs. 6.4 days (range 3–70 days) during post-intervention. Between baseline and post-intervention, IV antibiotics decreased from 1,161 antibiotic-days per 1,000 patient-days (PD/1,000) to 1,137 PD/1,000. Oral antibiotics decreased from 101 PD/1,000 to 77 PD/1,000. In addition, cephalosporins decreased from 526 PD/1,000 to 474 PD/1,000, and aminoglycosides decreased from 264 PD/1,000 to 117 PD/1,000. CONCLUSION: Appropriate antimicrobial use is vital in patients with a long length of stays in the hospital to reduce the development of multi-drug-resistant organisms. This intervention showed that a post-prescription review and feedback model can have impact in chronic wound and burn centers in Nepal and be further adapted for use in other LMIC. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6808960/ http://dx.doi.org/10.1093/ofid/ofz360.1719 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Nauriyal, Varidhi
Dhoj. Joshi, Rajesh
Raj Poudel, Suresh
Banstola, Laxman
Joshi, Anip
Acharya, Arjun
Bahadur Thapa, Buddhi
Shrestha, Basudha
Maki, Gina
Shakya, Malika
Man. Joshi, Nilesh
Karki, Kshitij
Bajracharya, Deepak
Gudipati, Smitha
Zervos, Marcus
Kaljee, Linda
Prentiss, Tyler
Rai, Shankar
2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal
title 2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal
title_full 2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal
title_fullStr 2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal
title_full_unstemmed 2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal
title_short 2039. Antibiotic Stewardship in Burn and Chronic Wound Centers in Nepal
title_sort 2039. antibiotic stewardship in burn and chronic wound centers in nepal
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6808960/
http://dx.doi.org/10.1093/ofid/ofz360.1719
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