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Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya

Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activiti...

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Autores principales: Omulo, Sylvia, Oluka, Margaret, Achieng, Loice, Osoro, Eric, Kinuthia, Rosaline, Guantai, Anastasia, Opanga, Sylvia Adisa, Ongayo, Marion, Ndegwa, Linus, Verani, Jennifer R., Wesangula, Eveline, Nyakiba, Jarred, Makori, Jones, Sugut, Wilson, Kwobah, Charles, Osuka, Hanako, Njenga, M. Kariuki, Call, Douglas R., Palmer, Guy H., VanderEnde, Daniel, Luvsansharav, Ulzii-Orshikh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202938/
https://www.ncbi.nlm.nih.gov/pubmed/35709220
http://dx.doi.org/10.1371/journal.pone.0270048
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author Omulo, Sylvia
Oluka, Margaret
Achieng, Loice
Osoro, Eric
Kinuthia, Rosaline
Guantai, Anastasia
Opanga, Sylvia Adisa
Ongayo, Marion
Ndegwa, Linus
Verani, Jennifer R.
Wesangula, Eveline
Nyakiba, Jarred
Makori, Jones
Sugut, Wilson
Kwobah, Charles
Osuka, Hanako
Njenga, M. Kariuki
Call, Douglas R.
Palmer, Guy H.
VanderEnde, Daniel
Luvsansharav, Ulzii-Orshikh
author_facet Omulo, Sylvia
Oluka, Margaret
Achieng, Loice
Osoro, Eric
Kinuthia, Rosaline
Guantai, Anastasia
Opanga, Sylvia Adisa
Ongayo, Marion
Ndegwa, Linus
Verani, Jennifer R.
Wesangula, Eveline
Nyakiba, Jarred
Makori, Jones
Sugut, Wilson
Kwobah, Charles
Osuka, Hanako
Njenga, M. Kariuki
Call, Douglas R.
Palmer, Guy H.
VanderEnde, Daniel
Luvsansharav, Ulzii-Orshikh
author_sort Omulo, Sylvia
collection PubMed
description Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.
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spelling pubmed-92029382022-06-17 Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya Omulo, Sylvia Oluka, Margaret Achieng, Loice Osoro, Eric Kinuthia, Rosaline Guantai, Anastasia Opanga, Sylvia Adisa Ongayo, Marion Ndegwa, Linus Verani, Jennifer R. Wesangula, Eveline Nyakiba, Jarred Makori, Jones Sugut, Wilson Kwobah, Charles Osuka, Hanako Njenga, M. Kariuki Call, Douglas R. Palmer, Guy H. VanderEnde, Daniel Luvsansharav, Ulzii-Orshikh PLoS One Research Article Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas. Public Library of Science 2022-06-16 /pmc/articles/PMC9202938/ /pubmed/35709220 http://dx.doi.org/10.1371/journal.pone.0270048 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Omulo, Sylvia
Oluka, Margaret
Achieng, Loice
Osoro, Eric
Kinuthia, Rosaline
Guantai, Anastasia
Opanga, Sylvia Adisa
Ongayo, Marion
Ndegwa, Linus
Verani, Jennifer R.
Wesangula, Eveline
Nyakiba, Jarred
Makori, Jones
Sugut, Wilson
Kwobah, Charles
Osuka, Hanako
Njenga, M. Kariuki
Call, Douglas R.
Palmer, Guy H.
VanderEnde, Daniel
Luvsansharav, Ulzii-Orshikh
Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
title Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
title_full Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
title_fullStr Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
title_full_unstemmed Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
title_short Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
title_sort point-prevalence survey of antibiotic use at three public referral hospitals in kenya
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202938/
https://www.ncbi.nlm.nih.gov/pubmed/35709220
http://dx.doi.org/10.1371/journal.pone.0270048
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