Impact of a hub-and-spoke approach to hospital antimicrobial stewardship programmes on antibiotic use in Zambia.

IF 3.7 Q2 INFECTIOUS DISEASES

JAC-Antimicrobial Resistance Pub Date : 2024-11-05 eCollection Date: 2024-12-01 DOI:10.1093/jacamr/dlae178

Aubrey Chichonyi Kalungia, Martin Kampamba, David Banda, Andrew Munkuli Bambala, Sarah Marshall, Melanie Newport, Anja St Clair-Jones, Luke Alutuli, Elias Chambula, Lucky Munsaka, Audrey Hamachila, Chiluba Mwila, Duncan Chanda, Joseph Chizimu, Roma Chilengi, Michael Okorie

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Abstract

Background: Antimicrobial stewardship programmes (ASPs) aim to optimize antibiotic use and prevent antimicrobial resistance.

Objective: This study assessed the impact of ASPs, initiated using a hub-and-spoke approach, on antibiotic use in Zambian public hospitals.

Methods: A pre-post study was conducted in 10 ASP-naive hospitals across Zambia using the Centers for Disease Control and Prevention (CDC)'s hospital-based ASP core elements (i.e. leadership, accountability, pharmacy expertise, stewardship actions, tracking progress, reporting and education) checklist and the global point prevalence survey methodology. The intervention involved technical staff from a national 'hub' hospital with an established ASP providing on-site orientation and mentorship to multidisciplinary teams of healthcare workers at 10 'spoke' hospitals to build capacity in antimicrobial stewardship. ASP core elements and inpatient antibiotic use prevalence (AUP) were assessed before and 12 months after ASP implementation. Data were statistically analysed.

Results: The adoption of ASP core elements improved significantly (P = 0.001, 95% CI: -17.8 to -5.42). AUP decreased from 50.1% (±5.8, n = 1477) to 44.3% (±4.6, n = 1400) after 12 months, though the reduction was not statistically significant (P = 0.442; 95% CI: -9.8 to 21.6), with 'Watch' list antibiotics remaining the most commonly prescribed across the hospitals.

Conclusions: The hub-and-spoke approach successfully catalysed ASPs in public hospitals in Zambia, demonstrating the potential for improving antibiotic use practices over time, provided structural challenges are addressed. This approach and insights can guide stakeholders in Zambia and similar settings in enhancing hospital ASPs.

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赞比亚医院抗菌药物管理计划的中心辐射方法对抗生素使用的影响。

背景：抗菌药物管理计划（ASP）旨在优化抗生素的使用并预防抗生素耐药性：抗菌药物管理计划（ASP）旨在优化抗生素的使用并预防抗生素耐药性：本研究评估了赞比亚公立医院采用 "中心辐射"（hub-and-spoke）方式启动的抗菌药物管理计划对抗生素使用的影响：方法：采用美国疾病控制和预防中心（CDC）的医院 ASP 核心要素（即领导力、问责制、药学专业知识、监管行动、进展跟踪、报告和教育）核对表和全球点流行率调查方法，在赞比亚 10 家未开展 ASP 的医院开展了一项事前-事后研究。干预措施包括由一家已建立 ASP 的国家 "中心 "医院的技术人员为 10 家 "辐射 "医院的多学科医护人员团队提供现场指导和辅导，以提高抗菌药物管理能力。在 ASP 实施前和实施 12 个月后，对 ASP 核心要素和住院病人抗生素使用率 (AUP) 进行了评估。对数据进行了统计分析：结果：ASP 核心要素的采用率显著提高（P = 0.001，95% CI：-17.8 至-5.42）。12 个月后，AUP 从 50.1%（±5.8，n = 1477）降至 44.3%（±4.6，n = 1400），但降幅无统计学意义（P = 0.442；95% CI：-9.8 至 21.6）：在解决结构性挑战的前提下，"中心辐射 "方法成功地促进了赞比亚公立医院的抗生素应用，显示出随着时间的推移改善抗生素使用实践的潜力。这种方法和见解可以指导赞比亚和类似环境中的利益相关者加强医院的 ASPs。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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