Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

Abstract

IntroductionAntimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use.Methods and analysisThe study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs.Ethics and disseminationApprovals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.

Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

“…Due to ethical considerations, two facilities (one county referral hospital and the Sub-county referral hospital) located in one county are designated as county I in this study, and the one county referral hospital in another county referred to as county II. The study was nested within an ongoing antimicrobial stewardship project that levers on implementation science approaches to understanding and enhancing AMS best practices in select health facilities in Kenya [ 12 ].…”

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

“…These programs have resulted in improving the prescribing habits of not only physicians, but surgeons as well, and improved awareness of the public and professionals. With the inclusion of hospital pharmacists in the stewardship team to lead the stewardship activities, significant reductions in the misuse of antibiotics have been observed [ 22 , 25 , 26 ]. Similarly, another study conducted in Jordan also aimed to evaluate the adherence of hospitals to the core elements of antibiotic stewardship and reported slow adoption and poor implementation of interventions in the country [ 27 ].…”

Antibiotic Resistance: One Health One World Outlook

“…Since human and animal health, food/feed and animal production systems, and agro-ecological environments are directly associated with ABR. Therefore, a multidimensional One Health approach is direly needed to circumvent ABR globally ( Gitaka et al., 2020 ). In this regard, the FAO-OIE-WHO alliance took the initiative in collaboration with public and private organizations to mitigate the global menace of ABR at the animal-human-environment nexus.…”

“…A global initiative named the Global Antibiotic Resistance Partnership (GARP) was launched in 2009 to form an action plan for the control of ABR in LMICs. Under the Tripartite’s Commitment FAO-OIE-WHO initiative, regional, local, and global efforts have been launched to report ABR and implement action plans by different countries ( Bank, 2010 ; Gitaka et al., 2020 ).…”