Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi



Lester, Rebecca, Haigh, Kate ORCID: 0000-0003-1901-7315, Wood, Alasdair, MacPherson, Eleanor E, Maheswaran, Hendramoorthy ORCID: 0000-0002-7375-4845, Bogue, Patrick, Hanger, Sofia, Kalizang'oma, Akuzike, Srirathan, Vinothan, Kulapani, David
et al (show 8 more authors) (2020) Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi. CLINICAL INFECTIOUS DISEASES, 71 (9). E478-E486.

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Abstract

<h4>Background</h4>Third-generation cephalosporins (3GC) remain the first-choice empiric antibiotic for severe infection in many sub-Saharan African hospitals. In Malawi, the limited availability of alternatives means that strategies to prevent the spread of 3GC resistance are imperative; however, suitable approaches to antimicrobial stewardship (AMS) in low-income settings are not well studied.<h4>Methods</h4>We introduced an AMS intervention to Queen Elizabeth Central Hospital in Blantyre. The intervention consisted of a prescribing application for smartphones and regular point-prevalence surveys with prescriber feedback. We evaluate the effects of the intervention on 3GC usage and on the cost of providing antibiotics. Using a thematic analysis of semi-structured interviews and participant observations, we additionally evaluate the acceptability of the stewardship program.<h4>Results</h4>The proportion of antibiotic prescriptions for a 3GC reduced from 193/241 (80.1%) to 177/330 (53.6%; percentage decrease, 26.5%; 95% confidence interval, 18.7-34.1) with no change in the case-fatality rate. The cost analysis estimated an annual savings of US$15 000. Qualitative research revealed trust in the guideline and found that its accessibility through smartphones helpful to guide clinical decisions. Operational health-system barriers and hierarchal clinical relationships lead to continued reliance on 3GC.<h4>Conclusions</h4>We report the successful introduction of an antimicrobial stewardship approach in Malawi. By focusing on pragmatic interventions and simple aims, we demonstrate the feasibility, acceptability, and cost savings of a stewardship program where resources are limited. In doing so, we provide a suitable starting point for expansions of AMS interventions in this and other low-income settings.

Item Type: Article
Uncontrolled Keywords: antimicrobial resistance, antimicrobial stewardship, Africa south of the Sahara
Depositing User: Symplectic Admin
Date Deposited: 21 Feb 2020 09:43
Last Modified: 19 Jan 2023 00:02
DOI: 10.1093/cid/ciaa162
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3075580