Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Eric S Donkor, Abdul-Halim Osman, Bill Clinton Aglomasa, Aaron Awere-Duodu, Alex Odoom, Bismark Opoku-Asare, Gilbert Lazarus
{"title":"Improving antibiotic utilization in West Africa: enhancing interventions through systematic review and evidence synthesis.","authors":"Eric S Donkor, Abdul-Halim Osman, Bill Clinton Aglomasa, Aaron Awere-Duodu, Alex Odoom, Bismark Opoku-Asare, Gilbert Lazarus","doi":"10.1186/s13756-024-01504-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Bacterial infection has been estimated to become the leading cause of death by 2050, causing 10 million deaths across the globe due to the surge in antibiotic resistance. Despite western sub-Saharan Africa being identified as one of the major hotspots of antimicrobial resistance (AMR) with the highest mortality, a comprehensive regional analysis of the magnitude and key drivers of AMR due to human antibiotic use has not been conducted.</p><p><strong>Method: </strong>We carried out a systematic review by conducting a comprehensive search in various databases including PubMed and Scopus for eligible articles published in the English Language between 1 January 2000 and 14 February 2024. Five key domains of antibiotic use were focused on: (1) antibiotic consumption; (2) appropriate antibiotic prescription; (3) indicators or key drivers of antibiotic use; (4) antimicrobial stewardship (AMS) interventions; (5) knowledge, attitudes and perceptions of antibiotic consumers and providers. Data were extracted from eligible papers for all the five domains under consideration and random-effects model meta-analysis was carried out for antibiotic consumption.</p><p><strong>Results: </strong>Out of the 2613 records obtained, 64 articles which were unevenly distributed in the region were eligible for inclusion in our study. These articles reported on antibiotic consumption (5), appropriate antibiotic prescription (10), indicators or key drivers of antibiotic use (10), AMS interventions (10), and 31 studies reported on knowledge, attitudes and perceptions. Antibiotic consumption for inpatients has a pooled estimate of 620.03 defined daily dose (DDD) per 100 bed-days (confidence interval [CI] 0.00-1286.67; I<sup>2</sup> = 100%) after accounting for outliers while prescribing appropriateness ranged from 2.5% to 93.0% with a pooled estimate of 50.09 ([CI: 22.21-77.92%], I<sup>2</sup> = 99.4%). Amoxicillin, gentamicin, amoxicillin-clavulanate, metronidazole, and ceftriaxone were the commonly consumed antibiotics. Community-acquired infection, hospital-acquired infection, and prophylaxis were the major indicators of antibiotic use. AMS was effective to varying degrees with bundled interventions and gamified antimicrobial stewardship decision support application being the most effective. Healthcare workers demonstrated acceptable antibiotic knowledge but individuals from formal and informal settings self-medicate with antibiotics and had moderate to low knowledge of antibiotic use and resistance.</p><p><strong>Conclusion: </strong>This review identified gaps in knowledge and highlighted areas where prompt actions are required, it further guides future research endeavors and policy development. The findings underscore the need for further implementation of AMS programs across the West African region to enhance understanding of antibiotic use patterns, prescribing practices, and the factors influencing them in the region.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"14 1","pages":"5"},"PeriodicalIF":4.8000,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789314/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial Resistance and Infection Control","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13756-024-01504-3","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Bacterial infection has been estimated to become the leading cause of death by 2050, causing 10 million deaths across the globe due to the surge in antibiotic resistance. Despite western sub-Saharan Africa being identified as one of the major hotspots of antimicrobial resistance (AMR) with the highest mortality, a comprehensive regional analysis of the magnitude and key drivers of AMR due to human antibiotic use has not been conducted.

Method: We carried out a systematic review by conducting a comprehensive search in various databases including PubMed and Scopus for eligible articles published in the English Language between 1 January 2000 and 14 February 2024. Five key domains of antibiotic use were focused on: (1) antibiotic consumption; (2) appropriate antibiotic prescription; (3) indicators or key drivers of antibiotic use; (4) antimicrobial stewardship (AMS) interventions; (5) knowledge, attitudes and perceptions of antibiotic consumers and providers. Data were extracted from eligible papers for all the five domains under consideration and random-effects model meta-analysis was carried out for antibiotic consumption.

Results: Out of the 2613 records obtained, 64 articles which were unevenly distributed in the region were eligible for inclusion in our study. These articles reported on antibiotic consumption (5), appropriate antibiotic prescription (10), indicators or key drivers of antibiotic use (10), AMS interventions (10), and 31 studies reported on knowledge, attitudes and perceptions. Antibiotic consumption for inpatients has a pooled estimate of 620.03 defined daily dose (DDD) per 100 bed-days (confidence interval [CI] 0.00-1286.67; I2 = 100%) after accounting for outliers while prescribing appropriateness ranged from 2.5% to 93.0% with a pooled estimate of 50.09 ([CI: 22.21-77.92%], I2 = 99.4%). Amoxicillin, gentamicin, amoxicillin-clavulanate, metronidazole, and ceftriaxone were the commonly consumed antibiotics. Community-acquired infection, hospital-acquired infection, and prophylaxis were the major indicators of antibiotic use. AMS was effective to varying degrees with bundled interventions and gamified antimicrobial stewardship decision support application being the most effective. Healthcare workers demonstrated acceptable antibiotic knowledge but individuals from formal and informal settings self-medicate with antibiotics and had moderate to low knowledge of antibiotic use and resistance.

Conclusion: This review identified gaps in knowledge and highlighted areas where prompt actions are required, it further guides future research endeavors and policy development. The findings underscore the need for further implementation of AMS programs across the West African region to enhance understanding of antibiotic use patterns, prescribing practices, and the factors influencing them in the region.

提高西非抗生素利用率:通过系统审查和证据综合加强干预措施。
背景:据估计,到2050年,细菌感染将成为导致死亡的主要原因,由于抗生素耐药性的激增,在全球造成1000万人死亡。尽管撒哈拉以南非洲西部被确定为抗菌素耐药性(AMR)的主要热点地区之一,死亡率最高,但尚未对人类抗生素使用导致的AMR的规模和主要驱动因素进行全面的区域分析。方法:我们对2000年1月1日至2024年2月14日期间发表的符合条件的英文文章在PubMed和Scopus等多个数据库中进行了全面检索,进行了系统评价。重点关注抗生素使用的五个关键领域:(1)抗生素消费;(2)适当的抗生素处方;(3)抗生素使用的指标或关键驱动因素;(4)抗菌素管理(AMS)干预措施;(5)抗生素消费者和提供者的知识、态度和观念。数据从考虑的所有五个领域的合格论文中提取,并对抗生素消费进行随机效应模型荟萃分析。结果:在获得的2613篇文献中,64篇在该地区分布不均匀的文献符合纳入我们的研究。这些文章报道了抗生素消费(5)、适当的抗生素处方(10)、抗生素使用的指标或关键驱动因素(10)、辅助医疗系统干预(10),以及31项关于知识、态度和观念的研究。住院患者的抗生素消耗汇总估计为每100个住院日620.03定义日剂量(DDD)(置信区间[CI] 0.00-1286.67;I2 = 100%),而处方适宜性范围为2.5% ~ 93.0%,合并估计为50.09 ([CI: 22.21 ~ 77.92%], I2 = 99.4%)。阿莫西林、庆大霉素、阿莫西林-克拉维酸、甲硝唑和头孢曲松是常用的抗生素。社区获得性感染、医院获得性感染和预防是抗生素使用的主要指标。AMS在不同程度上是有效的,捆绑干预和游戏化抗菌药物管理决策支持应用是最有效的。卫生保健工作者表现出可接受的抗生素知识,但来自正式和非正式环境的个人使用抗生素进行自我治疗,并且对抗生素使用和耐药性的知识中等至低。结论:本综述确定了知识上的差距,强调了需要迅速采取行动的领域,并进一步指导了未来的研究工作和政策制定。研究结果强调需要在整个西非地区进一步实施辅助医疗服务计划,以加强对该地区抗生素使用模式、处方做法及其影响因素的了解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信