{"title":"物尽其用:利用微生物学支持,为加纳一家地区医院的抗菌药物管理开发累积抗生素药敏报告。","authors":"Benedicta Bosu, Obed Kwabena Offe Amponsah, Phyllis Tawiah, Eric Darko, Nana Akua Abruquah, Annabella Bensusan Osafo, Emmanuel Sarkodie, Nana Bugyei Buabeng, Otridah Kapona, Alex Owusu-Ofori, Kwame Ohene Buabeng, Nana Kwame Ayisi-Boateng","doi":"10.1093/jacamr/dlae129","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antibiograms provide effective support for empirical prescribing and antimicrobial stewardship programmes (ASPs). In low-resource settings, microbiology systems to develop antibiograms may be rudimentary or entirely lacking, which may place such facilities at a disadvantage. Notwithstanding this, facilities should use what they have to support ASPs to inform evidence-based antibiotic use. We report how an antibiogram was developed at a district hospital in Ghana to support its ASP.</p><p><strong>Methods: </strong>This was a retrospective analysis of antibiotic susceptibility testing (AST) results from the University Hospital, KNUST from January to December 2021. Data were exported from the hospital's laboratory information system to Microsoft Excel (Version 2013). IBM SPSS Statistics (Version 25) and Epi Info™ Version 7 were used for statistical analyses.</p><p><strong>Results: </strong>Overall, 1949 cultures were performed, 392 (20.1%) growing bacterial pathogens. Per the CLSI M39-A4 standard guidelines for antibiograms, only 360 of the bacterial isolates were used for the analyses. The majority of isolates were from urine (187; 51.9%). Among the Gram-negative bacteria, there was low susceptibility to amoxicillin/clavulanic acid (28%), cephalosporins (11%-35%) and meropenem (21%), but high susceptibility to amikacin (96%) and levofloxacin (81%). Low susceptibility of Gram-positive isolates to amoxicillin/clavulanic acid (34%), meropenem (34%) and penicillins (27%-35%) was also recorded, but high susceptibility to ciprofloxacin (80%), gentamicin (79%) and vancomycin (76%).</p><p><strong>Conclusion: </strong>High levels of bacterial resistance to cephalosporins and meropenem in the antibiogram were reported. This antibiogram highlighted the urgent need for pragmatic steps to curb antibiotic resistance through ASPs using strategies that positively improve clinicians' knowledge and prescribing practices.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337119/pdf/","citationCount":"0","resultStr":"{\"title\":\"Use what you have: leveraging microbiology support to develop a cumulative antibiotic susceptibility report for antimicrobial stewardship at a district hospital in Ghana.\",\"authors\":\"Benedicta Bosu, Obed Kwabena Offe Amponsah, Phyllis Tawiah, Eric Darko, Nana Akua Abruquah, Annabella Bensusan Osafo, Emmanuel Sarkodie, Nana Bugyei Buabeng, Otridah Kapona, Alex Owusu-Ofori, Kwame Ohene Buabeng, Nana Kwame Ayisi-Boateng\",\"doi\":\"10.1093/jacamr/dlae129\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Antibiograms provide effective support for empirical prescribing and antimicrobial stewardship programmes (ASPs). In low-resource settings, microbiology systems to develop antibiograms may be rudimentary or entirely lacking, which may place such facilities at a disadvantage. Notwithstanding this, facilities should use what they have to support ASPs to inform evidence-based antibiotic use. We report how an antibiogram was developed at a district hospital in Ghana to support its ASP.</p><p><strong>Methods: </strong>This was a retrospective analysis of antibiotic susceptibility testing (AST) results from the University Hospital, KNUST from January to December 2021. Data were exported from the hospital's laboratory information system to Microsoft Excel (Version 2013). IBM SPSS Statistics (Version 25) and Epi Info™ Version 7 were used for statistical analyses.</p><p><strong>Results: </strong>Overall, 1949 cultures were performed, 392 (20.1%) growing bacterial pathogens. Per the CLSI M39-A4 standard guidelines for antibiograms, only 360 of the bacterial isolates were used for the analyses. The majority of isolates were from urine (187; 51.9%). Among the Gram-negative bacteria, there was low susceptibility to amoxicillin/clavulanic acid (28%), cephalosporins (11%-35%) and meropenem (21%), but high susceptibility to amikacin (96%) and levofloxacin (81%). Low susceptibility of Gram-positive isolates to amoxicillin/clavulanic acid (34%), meropenem (34%) and penicillins (27%-35%) was also recorded, but high susceptibility to ciprofloxacin (80%), gentamicin (79%) and vancomycin (76%).</p><p><strong>Conclusion: </strong>High levels of bacterial resistance to cephalosporins and meropenem in the antibiogram were reported. This antibiogram highlighted the urgent need for pragmatic steps to curb antibiotic resistance through ASPs using strategies that positively improve clinicians' knowledge and prescribing practices.</p>\",\"PeriodicalId\":14594,\"journal\":{\"name\":\"JAC-Antimicrobial Resistance\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-08-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337119/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JAC-Antimicrobial Resistance\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/jacamr/dlae129\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAC-Antimicrobial Resistance","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jacamr/dlae129","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
背景:抗生素图谱可为经验性处方和抗菌药物管理计划(ASP)提供有效支持。在资源匮乏的环境中,用于制定抗生素图谱的微生物学系统可能非常简陋或完全缺乏,这可能会使这些机构处于不利地位。尽管如此,医疗机构仍应利用现有资源支持 ASP,为循证使用抗生素提供依据。我们报告了加纳一家地区医院是如何制定抗生素图以支持其 ASP 的:这是一项对 2021 年 1 月至 12 月期间加纳科大大学医院抗生素药敏试验 (AST) 结果的回顾性分析。数据从医院的实验室信息系统导出到 Microsoft Excel(2013 版)。统计分析采用 IBM SPSS Statistics(25 版)和 Epi Info™ Version 7:总共进行了 1949 次培养,其中 392 次(20.1%)培养出细菌病原体。根据 CLSI M39-A4 抗生素图谱标准指南,只有 360 个细菌分离物被用于分析。大部分分离物来自尿液(187 个,占 51.9%)。在革兰氏阴性细菌中,对阿莫西林/克拉维酸(28%)、头孢菌素(11%-35%)和美罗培南(21%)的敏感性较低,但对阿米卡星(96%)和左氧氟沙星(81%)的敏感性较高。革兰氏阳性分离株对阿莫西林/克拉维酸(34%)、美罗培南(34%)和青霉素类(27%-35%)的敏感性也较低,但对环丙沙星(80%)、庆大霉素(79%)和万古霉素(76%)的敏感性较高:结论:在抗生素图谱中,细菌对头孢菌素和美罗培南的耐药性水平很高。该抗生素图突出表明,迫切需要采取务实的措施,利用积极改善临床医生知识和处方实践的策略,通过 ASP 抑制抗生素耐药性。
Use what you have: leveraging microbiology support to develop a cumulative antibiotic susceptibility report for antimicrobial stewardship at a district hospital in Ghana.
Background: Antibiograms provide effective support for empirical prescribing and antimicrobial stewardship programmes (ASPs). In low-resource settings, microbiology systems to develop antibiograms may be rudimentary or entirely lacking, which may place such facilities at a disadvantage. Notwithstanding this, facilities should use what they have to support ASPs to inform evidence-based antibiotic use. We report how an antibiogram was developed at a district hospital in Ghana to support its ASP.
Methods: This was a retrospective analysis of antibiotic susceptibility testing (AST) results from the University Hospital, KNUST from January to December 2021. Data were exported from the hospital's laboratory information system to Microsoft Excel (Version 2013). IBM SPSS Statistics (Version 25) and Epi Info™ Version 7 were used for statistical analyses.
Results: Overall, 1949 cultures were performed, 392 (20.1%) growing bacterial pathogens. Per the CLSI M39-A4 standard guidelines for antibiograms, only 360 of the bacterial isolates were used for the analyses. The majority of isolates were from urine (187; 51.9%). Among the Gram-negative bacteria, there was low susceptibility to amoxicillin/clavulanic acid (28%), cephalosporins (11%-35%) and meropenem (21%), but high susceptibility to amikacin (96%) and levofloxacin (81%). Low susceptibility of Gram-positive isolates to amoxicillin/clavulanic acid (34%), meropenem (34%) and penicillins (27%-35%) was also recorded, but high susceptibility to ciprofloxacin (80%), gentamicin (79%) and vancomycin (76%).
Conclusion: High levels of bacterial resistance to cephalosporins and meropenem in the antibiogram were reported. This antibiogram highlighted the urgent need for pragmatic steps to curb antibiotic resistance through ASPs using strategies that positively improve clinicians' knowledge and prescribing practices.