Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study

Gates Open Research

article

Alexander M. Aiken¹  Brian Nyamwaya²  Lola Madrid¹  Dumessa Edessa³  Appiah-Korang Labi⁴  Noah Obeng-Nkrumah⁵  William Mwabaya²  Mabvuto Chimenya⁶  Derek Cocker⁶  Kenneth C. Iregbu⁸  Philip I. P. Princewill-Nwajiobi⁸  Angela Dramowski⁹  Tolbert Sonda^1,10  Blandina Theophil Mmbaga^1,10  David Ojok^1,12  Sombo Fwoloshi^1,13  J Anthony G Scott¹  Andrew Whitelaw^1,14 

[1] Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine;KEMRI Centre for Geographic Medicine Research;School of Pharmacy, Haramaya University;Department of Medical Microbiology, University of Ghana Medical School;Department of Medical Laboratory Sciences, University of Ghana;Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences;Department of Clinical Sciences, Liverpool School of Tropical Medicine;Department of Medical Microbiology, National Hospital Abuja;Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University;Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre;Department of Paediatric and Child Health, Kilimanjaro Christian Medical University College;Centre for Infectious Disease Research in Zambia;Department of Medicine, University Teaching Hospital, Ministry of Health;Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University;National Health Laboratory Service, Tygerberg Hospital

关键词: antibiotic;    access;    infection;    resistance;    Africa;   

DOI  :  10.12688/gatesopenres.14267.1

学科分类：电子与电气工程

来源: American Journal Of Pharmtech Research

【 摘 要 】

Background: Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study.   Methods: We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI). Results: Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score: median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions: median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients.  Conclusions: There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, patient-level use reflected in-hospital drug availability, suggesting external antibiotics supply was infrequent. Antimicrobial resistant bacterial infections could plausibly show different clinical impacts across sub-Saharan Africa due to this contextual variation.

【 授权许可】

CC BY