An urgent need for antimicrobial stewardship in Indigenous rural and remote primary health care

Bowen, Asha C; Daveson, Kathryn; Anderson, Lorraine; Tong, Steven Y. C.

doi:10.5694/mja2.50216

Cited by 28 publications

(36 citation statements)

References 14 publications

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“…Although research around skin infections in Indigenous communities is limited, this high burden of infection aligns with the current literature; in Australia, researchers have found that 75% of residents from two remote Australian Indigenous communities visited a primary healthcare centre with a skin infection at least once in a year, and skin infections were the dominant reason for visiting a primary healthcare centres in Indigenous communities [19]. They also found MRSA rates around 50% in the north (of Australia) [20], and highlighted the high burden of skin infections in Indigenous communities in Australia. The findings of this study adds to the literature and emphasize the need to improve health equity for First Nations populations and support for nursing stations to providing prompt and adequate care to meet population needs.…”

Section: Discussionsupporting

confidence: 57%

Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

et al. 2020

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Background: Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting. Methods: A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥ 18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment. Results: A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA. Conclusions: This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and underrepresented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

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Section: Discussionsupporting

confidence: 57%

Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

et al. 2020

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“…This study is the first to report on appropriateness of prescriptions within remote Aboriginal Australian communities, and previous reports have noted the need for such data. [2,9,19] In this study, 65% of prescriptions had recorded infections that aligned with CARPA guidelines. Only 8% of prescriptions had an infection recorded which did not align, and 27% of prescriptions had no infection recorded, significantly lower than that reported in AURA 2017.…”

Section: Plos Onementioning

confidence: 65%

“…Whilst acknowledging the diversity in Aboriginal and Torres Strait Islander peoples' languages, culture and community populations, the provision and accessibility of PHC services and the prevalence of infections are not dissimilar across the Top End of Australia. [19] Participant recruitment and consent From February to May 2016 locally trained Aboriginal Community Based Researchers went house to house to discuss the research project with families who potentially had children born between 1 January 2010 and 31 July 2014. Written informed consent was obtained from mothers/caregivers who agreed to having the electronic health records of their child's PHC presentations in the first two years of life extracted for review.…”

Section: Study Design and Settingmentioning

confidence: 99%

Antibiotic use for Australian Aboriginal children in three remote Northern Territory communities

et al. 2020

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Objective To describe antibiotic prescription rates for Australian Aboriginal children aged <2 years living in three remote Northern Territory communities. Design A retrospective cohort study using electronic health records. Setting Three primary health care centres located in the Katherine East region. Participants Consent was obtained from 149 mothers to extract data from 196 child records. There were 124 children born between January 2010 and July 2014 who resided in one of the three chosen communities and had electronic health records for their first two years of life. Main outcome measures Antibiotic prescription rates, factors associated with antibiotic prescription and factors associated with appropriate antibiotic prescription.

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“…It offers a mechanism to support clinical and public health decision-making and guideline www.nature.com/scientificreports/ development. The urgent need to improve antimicrobial stewardship in the remote and disadvantaged regions of central and northern Australia has been recently highlighted 8 . A comprehensive epidemiology of S. aureus across tropical north of Australia has not previously been reported.…”

Section: Discussionmentioning

confidence: 99%

Geospatial epidemiology of Staphylococcus aureus in a tropical setting: an enabling digital surveillance platform

Wozniak

Cuningham

Buchanan

et al. 2020

Sci Rep

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Delivery of information to clinicians on evolving antimicrobial susceptibility needs to be accurate for the local needs, up-to-date and readily available at point of care. In northern Australia, bacterial infection rates are high but resistance to first-and second-line antibiotics is poorly described and currently-available datasets exclude primary healthcare data. We aimed to develop an online geospatial and interactive platform for aggregating, analysing and disseminating data on regional bacterial pathogen susceptibility. We report the epidemiology of Staphylococcus aureus as an example of the power of digital platforms to tackle the growing spread of antimicrobial resistance in a high-burden, geographically-sparse region and beyond. We developed an online geospatial platform called Hotspots that visualises antimicrobial susceptibility patterns and temporal trends. Data on clinically-important bacteria and their antibiotic susceptibility profiles were sought from retrospectively identified clinical specimens submitted to three participating pathology providers (96 unique tertiary and primary healthcare centres, n = 1,006,238 tests) between January 2008 and December 2017. Here we present data on S. aureus only. Data were available on specimen type, date and location of collection. Regions from the Australian Bureau of Statistics were used to provide spatial localisation. the online platform provides an engaging visual representation of spatial heterogeneity, demonstrating striking geographical variation in S. aureus susceptibility across northern Australia. Methicillin resistance rates vary from 46% in the west to 26% in the east. Plots generated by the platform show temporal trends in proportions of S. aureus resistant to methicillin and other antimicrobials across the three jurisdictions of northern Australia. A quarter of all, and up to 35% of methicillin-resistant S. aureus (MRSA) blood isolates in parts of the northern Australia were resistant to inducible-clindamycin. Clindamycin resistance rates in MRSA are worryingly high in regions of northern Australia and are a local impediment to empirical use of this agent for community MRSA. Visualising routinely collected laboratory data with digital platforms, allows clinicians, public health physicians and guideline developers to monitor and respond to antimicrobial resistance in a timely manner. Deployment of this platform into clinical practice supports national and global efforts to innovate traditional disease surveillance systems with the use of digital technology and to provide practical solutions to reducing the threat of antimicrobial resistance.

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An urgent need for antimicrobial stewardship in Indigenous rural and remote primary health care

Cited by 28 publications

References 14 publications

Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

Antibiotic use among twelve Canadian First Nations communities: a retrospective chart review of skin and soft tissue infections

Antibiotic use for Australian Aboriginal children in three remote Northern Territory communities

Geospatial epidemiology of Staphylococcus aureus in a tropical setting: an enabling digital surveillance platform

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