Assessment of Adherence to the Core Elements of Hospital Antibiotic Stewardship Programs: A Survey of the Tertiary Care Hospitals in Punjab, Pakistan

Abstract

Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of “YES”, “NO” or “Under Process” constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated “Perfect” adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were “Poor“ in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes.Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or ”Under Process”. The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan.

Understanding of Final Year Medical, Pharmacy and Nursing Students in Pakistan towards Antibiotic Use, Antimicrobial Resistance and Stewardship: Findings and Implications

“…These concerns may be due to a lack of information regarding ASPs and their importance in the current curriculum, which needs to be urgently addressed. We are aware that there have been concerns that it is difficult to fully instigate ASPs in LMICs due to resource and available personnel issues, as well as a lack of knowledge [41,107]. However, this is changing, as seen, for instance, in Africa, as well as other LMICs [22,27,[108][109][110].…”

“…were resistant to erythromycin [34]. Moreover, previous studies from Pakistan have highlighted poor compliance with hand hygiene protocols in hospitals [38], poor adherence to standard treatment guidelines [39][40][41], overprescribing of antibiotics where these are not needed, overprescribing of broad-spectrum antibiotics instead of narrow-spectrum ones among different age groups and the extensive self-purchasing of antibiotics without a prescription, combined with poor enforcement of drug regulations [42][43][44][45][46][47][48][49][50]. All of these practices need to be urgently addressed to reduce future AMR.…”

Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications

“…Having said this, there have been initiatives to improve antibiotic use using antibiotic stewardship program (ASP) in Pakistan. 36 , 37 In view of this, we sought to evaluate the impact of positive culture sensitivity reports of E. coli or MSSA on subsequent antibiotics use pattern within a leading teaching hospital in Pakistan. We believe the findings will not only be useful in this hospital but also in hospitals throughout Pakistan and wider as they seek to reduce AMR to these two leading organisms within hospitals as part of the National Action Plan to reduce AMR in Pakistan.…”

How Are We Educating Future Physicians and Pharmacists in Pakistan? A Survey of the Medical and Pharmacy Student’s Perception on Learning and Preparedness to Assume Future Roles in Antibiotic Use and Resistance

“…Pakistan, an LMIC in South Asia, is an important region for interventions to reduce the growing ABR owing to its huge population of 216 million inhabitants [8]. Officially, there are 62 medical colleges (19 public, 43 private) in Punjab and Islamabad [9].…”

“…Studies have warned of pervasive overprescribing by physicians in hospitals and the sale of antibiotics without prescription in community settings in Pakistan [11]. Significant gaps exist in the continuous education of healthcare professionals on optimal antibiotic use and growing resistance in tertiary care hospitals [8,12]. Whether these gaps originate from a lack of training and education at the beginning (during the undergraduate degree program, such as MBBS or Pharm D) or during professional practices, remains a debatable issue.…”