Nauriyal V, Rai SM, Joshi RD, Thapa BB, Kaljee L, Prentiss T, Maki G, Shrestha B, Bajracharya DC, Karki K, Joshi N, Acharya A, Banstola L, Poudel SR, Joshi A, Dahal A, Palikhe N, Khadka S, Giri P, Lamichhane A, Zervos M, et al.
Antibiotics (Basel, Switzerland). Date of publication 2020 Dec 16;volume 9(12):.
1. Antibiotics (Basel). 2020 Dec 16;9(12). pii: E914. doi:
10.3390/antibiotics9120914.
Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in
Three Hospitals in Nepal.
Nauriyal V(1), Rai SM(2), Joshi RD(3), Thapa BB(4), Kaljee L(5), Prentiss T(5),
Maki G(1), Shrestha B(3), Bajracharya DC(6), Karki K(6), Joshi N(6), Acharya
A(4), Banstola L(4), Poudel SR(4), Joshi A(4), Dahal A(3), Palikhe N(3), Khadka
S(3), Giri P(2), Lamichhane A(2), Zervos M(1).
Author information:
(1)Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202,
USA.
(2)Kirtipur Hospital, Kathmandu 44600, Nepal.
(3)Kathmandu Model Hospital, Kathmandu 44600, Nepal.
(4)Pokhara Academy of Health Science, Pokhara 33700, Nepal.
(5)Global Health Initiative, Henry Ford Health System, Detroit, MI 48202, USA.
(6)Group for Technical Assistance, Kathmandu 44600, Nepal.
Antimicrobial stewardship (AMS) programs can decrease non-optimal use of
antibiotics in hospital settings. There are limited data on AMS programs in burn
and chronic wound centers in low- and middle-income countries (LMIC). A
post-prescription review and feedback (PPRF) program was implemented in three
hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline
and 236 post-intervention patient chart data were collected from three hospitals.
There was a significant decrease in utilizing days of therapy per 1000 patient
days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and
cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were
significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other
antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals,
e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001)
and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model
Hospital (p = 0.59). An independent review conducted by infectious disease
specialists at the Henry Ford Health System revealed significant changes in
antibiotic prescribing practices both overall and by hospital. There was a
decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD
8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no
difference for oral antibiotics. Compared to baseline, over the 6-month
post-intervention period, we found an increase in justified use of antibiotics (p
< 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and
adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and
after diagnoses (p < 0.001). The evaluation data presented provide evidence that
PPRF training and program implementation can contribute to hospital-based
antibiotic stewardship for wound and burn care in Nepal.
DOI: 10.3390/antibiotics9120914
PMCID: PMC7766399
PMID: 33339283
