Roll out of a successful antimicrobial stewardship programme in Lagos University Teaching Hospital Nigeria using the Global-Point Prevalence Survey

Abstract

Background: Antimicrobial resistance (AMR) has become a public health emergency with increasing rates and spread globally. Antimicrobial stewardship (AMS) has been advocated to reduce the burden of antimicrobial resistance, promote rational and appropriate use of antibiotics and improve clinical outcomes. Education and training are one of the AMS interventions to improve antimicrobial use. We present the roll out of a successful AMS programme with education and training using the Global-PPS as data collection tool to measure AMS interventions and impact.Methodology: This was a cross sectional study on the implementation of an AMS programme at the Lagos University Teaching Hospital. Global PPS was conducted in 2015 to collect baseline data which was used to identify targets for quality improvement in AMS and was repeated in 2017 and 2018 to measure impact of AMS interventions. AMS interventions included education, feedback of Global-PPS result and writing of the hospitalwide antibiotic policy based on the baseline data.Results: Out of the 746 inpatients surveyed, 476 (68.3%) had received at least one antimicrobial on the days of Global-PPS. The antimicrobial prescribing rates reduced significantly over the three time periods. In 2015, 82.5% were placed on antimicrobials, 65.5% in 2017 and 51.1% in 2018 (p<0.00001). The documentation of indication for treatment significantly improved from 53.4% in 2015 to 97.2% in 2018 (p<0.0001). Stop review date also significantly improved from 28.7% to 70.2% in 2018 (p<0.00001). Surgical prophylaxis for more than 24 hours reduced significantly from 93.3% in 2015 to 65.7% in 2018 (p=0.002) even though the prevalence was still high. The three most commonly administered antimicrobial groups were third generation cephalosporins, imidazole derivatives and quinolones. The most commonly prescribed antibiotics for surgical prophylaxis were ceftriaxone and metronidazole in 2015 and ceftriaxone in 2017.Conclusion: The use of education and training as AMS intervention in a limited resource setting clearly made impact on antimicrobial prescribing patterns in the hospital. Global-PPS is useful to set quality improvement targets and for monitoring, evaluation and surveillance of an AMS programme.
 Keywords: Antibiotic, Stewardship, Resistance, Education, Global-PPS

Implementation of Antimicrobial Stewardship in a District Hospital in the Ashanti Region of Ghana Using a Health Partnership Model

“…This is comparable to a national AMS project in China over a year (2011-2012) which reported a reduction in antibiotic use from 68% to 58% among inpatients [20]. Prevalence of antibiotic use in this project was however higher at the endpoint than in a project from Nigeria where antibiotic use reduced from 82.5% at baseline, 68.3% at midpoint and 51.1% at endpoint [21]. The Nigerian project however ran between 2015 and 2018 compared to the current project which implemented AMS over a seven-month period.…”

Documenting the indication for antimicrobial prescribing: a scoping review

“…An additional 15 citations were identified from the grey literature search for a total of 123 publications (figure 1). 13–135 Of the 123 studies, 64 were peer reviewed, 53 were conference proceedings and 6 were online documents (eg, reports).…”

“…There were 32 studies18 20 22 30 33–37 39 41–44 58 59 62 63 66 68 69 86 88 93 96 105 107 113 120 123 131 134 that assessed interventions to increase the prevalence of antimicrobial indication documentation and one study that evaluated an intervention to improve indication accuracy 24. Most studies were in the hospital setting (n=30, 94%).…”

Towards an Antimicrobial Stewardship Program in a Young Tertiary Hospital in Southern Nigeria: A Point Prevalence Survey of Antimicrobial Usage

“…All forty-five patients were on a total of eighty-one (81) prescriptions. Patients on the medical ward (24) were on a total of forty-five prescriptions (Figure 2) while those on the surgical wards (21) were on a total of thirty-six prescriptions (Figure 3). Third generation cephalosporins, imidazole derivatives and fluoroquinolones were most prescribed and accounted for 24.4%, 17.8% and 20% of all prescriptions on the medical wards (Figure 2).…”

“…Education is one strategy of the ASP that has proven to be very effective [20]. Following antimicrobial stewardship interventions, improved use of laboratory evidence to guide antimicrobial usage has been recognized [11] [21]. Poor healthcare funding and the relative inaccessibility of majority of Nigerians to health insurance, thus necessitating out-of-pocket payments for health care services and laboratory tests is also a major contributor to underutilization of diagnostic services in Nigeria [22].…”