A Feasible Laboratory-Strengthening Intervention Yielding a Sustainable Clinical Bacteriology Sector to Support Antimicrobial Stewardship in a Large Referral Hospital in Ethiopia

Abstract

The laboratory is on the path toward SLIPTA accreditation by the African Society for Laboratory Medicine. Reagent costs, staff training and retention, and engagement of clinical personnel with the lab proved to be manageable challenges. Key external challenges include in-country supply-chain management issues, lack of competition among distributors, and foreign-currency exchange distortions. Conclusions: Using a relatively low-intensity intervention based on existing training tools and accreditation schemes, we demonstrate that establishment of reasonable-quality clinical bacteriology is not only within reach but also a critical step toward assessing the burden of AMR in settings like this one and implementing effective stewardship strategies.

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

“…By focusing most of our feedback on duration of treatment, we were able to recommend discontinuing antibiotics in over 50% of cases. Since the wards we targeted were the main consumers of costly antibiotics, an intervention limited to only 25% of patients on just 2 wards resulted in substantial cost savings for the entire institution: antibiotic costs decreased by an amount equivalent to 35,000 USD (19% reduction compared to the year preceding the intervention)-equivalent to the total cost of laboratory reagents invested in support of the bacteriology laboratory (7).…”

“…We recently implemented a laboratory bundle intervention aimed at improving bacteriology services in Ethiopia's largest teaching and referral hospital, which currently contributes a significant proportion of the national AMR surveillance data (7). In the first year after implementation, we reported widespread resistance of gram-negative bacteria to locally available antibiotics including carbapenems, a class of antibiotics which had been introduced in Ethiopia only 3 years prior (8).…”

Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries

“…Incentives, such as patient health insurance coverage and hospital reimbursement coverage to support the costs of microbiology testing, may support this shift and motivate the utilization of microbiology testing in LMIC settings. A healthy and dedicated liaison between the qualified microbiology laboratory and clinicians is also crucial to increase mutual trust and to optimise use of existing diagnostic tools [62][63][64]. Moreover, a clear potential advancement in career pathway for the qualified microbiologist and laboratory technicians could further enhance trust and uptake of microbiology results.…”

Cost–utility analysis of antimicrobial stewardship programme at a tertiary teaching hospital in Ethiopia

“…11 12 We recently demonstrated the feasibility and impact of a laboratory intervention aimed at informing therapeutic decisions through basic but adequate microbiological workup. 12 Before beginning a laboratory-strengthening intervention, we conducted a need assessment and found that the bacteriology laboratory was under-resourced, resulting in inadequate infrastructure, varying staff proficiency, lack of essential supplies such as reagents to conduct key tests and lack of standardisation. 12 Moreover, clinicians' distrust of laboratory results coupled with poor collaborative relationship with laboratory personnel contributed to the laboratory's underutilisation.…”