Category: Antimicrobial Stewardship: Program Development and Implementation

Poster Session: Antimicrobial Stewardship: Program Development and Implementation

158 - A multi-site, prospective study of antimicrobial prescribing practices in three low- or middle-income country hospitals

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Presenting Author(s)

RR

Robert J. Rolfe

Infectious Diseases Fellow
Duke University
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

FM

Florida Muro

Head of Community Health Department-KCMC Lecturer
Institute of Public Health (IPH)
Moshi, Kilimanjaro, Tanzania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
FL

Furaha Lyamuya

MD
Kilimanjaro Christian Medical Centre
Moshi, Kilimanjaro, Tanzania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CK

Charles M. Kwobah

Assistant Lecturer
Moi Teaching and Referral Hospital
Eldoret, Rift Valley, Kenya
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TS

Tianchen Sheng

Ms.
Duke University Medical Center
Durham, NC
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DP

Dammalage Lasanthi Bhagya Piyasiri

Head of Microbiology
Teaching Hospital Karapitiya
Galle, Southern Province, Sri Lanka
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CB

Champica K. Bodinayake

Head of Department
University of Ruhuna
Galle, Southern Province, Sri Lanka
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AN

Ajith Nagahawatte

Professor of Microbiology
University of Ruhuna
Galle, Southern Province, Sri Lanka
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Michael E. Yarrington

Assistant Professor
Duke University Health System
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Richard H. Drew

Professor of Medicine / Professor of Pharmacy
Duke School of Medicine/Campbell University College of Pharmacy & Health Sciences
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PK

Peter S. Kussin

Professor of Medicine
Duke University
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MW

Melissa H. Watt

Research Associate Professor
University of Utah School of Medicine
Salt Lake City, Utah
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DA

Deverick J. Anderson

Professor
Duke Center for Antimicrobial Stewardship and Infection Prevention
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CW

Christopher W. Woods

Professor of Medicine
Duke University
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BM

Blandina T. Mmbaga

Director
Kilimanjaro Christian Medical Centre
Moshi, Kilimanjaro, Tanzania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LT

L Gayani Tillekeratne

Assistant Professor
Duke University
Durham, North Carolina
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Antimicrobial stewardship programs (ASPs) are being developed internationally to mitigate the misuse of antimicrobials. An understanding of current practices and prescribing patterns is necessary to determine targets to develop context-specific ASPs in low- and middle-income country (LMIC) hospitals.

Methods: We conducted a prospective study of patients admitted to the adult medical wards at three LMIC tertiary care centers in 2018- 2019: a 1,800-bed public hospital in Galle, Sri Lanka; a 991-bed public hospital in Eldoret, Kenya; and a 630-bed private hospital in Moshi, Tanzania. Information regarding antimicrobial therapy received during hospitalization, indications for antimicrobial therapy, and duration of antimicrobial use were extracted from the medical record.

Results: In total, 3150 patients were enrolled: 1297 in Sri Lanka, 750 in Kenya, and 1103 in Tanzania. Antimicrobial use prevalence varied between the three sites, with 56.0% of patients receiving antimicrobials during hospitalization in Sri Lanka, 56.5% in Kenya, and 35.4% in Tanzania. Third-generation cephalosporins were used most frequently in Kenya (70.0%) and Tanzania (73.1%), whereas amoxicillin/ clavulanic acid was used most frequently in Sri Lanka (48.4%). Lower respiratory tract infection was the most common indication for antimicrobial use in all three locations: 37.4% in Sri Lanka, 27.8% in Kenya, and 49.2% in Tanzania. No clear indication for antimicrobial use was documented among 11.6% patients receiving antimicrobials in Sri Lanka, 32.8% in Kenya, and 10.5% in Tanzania. In Tanzania, 8.6% of the patients had documentation of input from the microbiology or infectious diseases teams compared to less than 1% in either Sri Lanka or Kenya. Pertinent culture data related to the primary indication for antimicrobials was present in 16.1% (Sri Lanka), 6.1% (Kenya), and 7.4% (Tanzania).

Conclusion: Unclear documentation for antimicrobial use was common in all three sites and most patients on antimicrobial therapy did not have pertinent culture data. Improving documentation and the capacity of the local microbiology laboratories could be initial targets for ASPs in these LMIC hospitals.