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Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal

Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in th...

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Autores principales: Nauriyal, Varidhi, Rai, Shankar Man, Joshi, Rajesh Dhoj, Thapa, Buddhi Bahadur, Kaljee, Linda, Prentiss, Tyler, Maki, Gina, Shrestha, Basudha, Bajracharya, Deepak C., Karki, Kshitij, Joshi, Nilesh, Acharya, Arjun, Banstola, Laxman, Poudel, Suresh Raj, Joshi, Anip, Dahal, Abhinav, Palikhe, Niranjan, Khadka, Sachin, Giri, Piyush, Lamichhane, Apar, Zervos, Marcus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766399/
https://www.ncbi.nlm.nih.gov/pubmed/33339283
http://dx.doi.org/10.3390/antibiotics9120914
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author Nauriyal, Varidhi
Rai, Shankar Man
Joshi, Rajesh Dhoj
Thapa, Buddhi Bahadur
Kaljee, Linda
Prentiss, Tyler
Maki, Gina
Shrestha, Basudha
Bajracharya, Deepak C.
Karki, Kshitij
Joshi, Nilesh
Acharya, Arjun
Banstola, Laxman
Poudel, Suresh Raj
Joshi, Anip
Dahal, Abhinav
Palikhe, Niranjan
Khadka, Sachin
Giri, Piyush
Lamichhane, Apar
Zervos, Marcus
author_facet Nauriyal, Varidhi
Rai, Shankar Man
Joshi, Rajesh Dhoj
Thapa, Buddhi Bahadur
Kaljee, Linda
Prentiss, Tyler
Maki, Gina
Shrestha, Basudha
Bajracharya, Deepak C.
Karki, Kshitij
Joshi, Nilesh
Acharya, Arjun
Banstola, Laxman
Poudel, Suresh Raj
Joshi, Anip
Dahal, Abhinav
Palikhe, Niranjan
Khadka, Sachin
Giri, Piyush
Lamichhane, Apar
Zervos, Marcus
author_sort Nauriyal, Varidhi
collection PubMed
description Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.
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spelling pubmed-77663992020-12-28 Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal Nauriyal, Varidhi Rai, Shankar Man Joshi, Rajesh Dhoj Thapa, Buddhi Bahadur Kaljee, Linda Prentiss, Tyler Maki, Gina Shrestha, Basudha Bajracharya, Deepak C. Karki, Kshitij Joshi, Nilesh Acharya, Arjun Banstola, Laxman Poudel, Suresh Raj Joshi, Anip Dahal, Abhinav Palikhe, Niranjan Khadka, Sachin Giri, Piyush Lamichhane, Apar Zervos, Marcus Antibiotics (Basel) Article Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal. MDPI 2020-12-16 /pmc/articles/PMC7766399/ /pubmed/33339283 http://dx.doi.org/10.3390/antibiotics9120914 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nauriyal, Varidhi
Rai, Shankar Man
Joshi, Rajesh Dhoj
Thapa, Buddhi Bahadur
Kaljee, Linda
Prentiss, Tyler
Maki, Gina
Shrestha, Basudha
Bajracharya, Deepak C.
Karki, Kshitij
Joshi, Nilesh
Acharya, Arjun
Banstola, Laxman
Poudel, Suresh Raj
Joshi, Anip
Dahal, Abhinav
Palikhe, Niranjan
Khadka, Sachin
Giri, Piyush
Lamichhane, Apar
Zervos, Marcus
Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
title Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
title_full Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
title_fullStr Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
title_full_unstemmed Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
title_short Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
title_sort evaluation of an antimicrobial stewardship program for wound and burn care in three hospitals in nepal
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766399/
https://www.ncbi.nlm.nih.gov/pubmed/33339283
http://dx.doi.org/10.3390/antibiotics9120914
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