WoundReference improves clinical decisions
 Choose the role that best describes you
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
Appears in following Topics:
Antimicrobial Stewardship In Wound Care