Frontiers in Public Health (Apr 2022)

Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries

  • Florida J. Muro,
  • Florida J. Muro,
  • Florida J. Muro,
  • Furaha S. Lyamuya,
  • Furaha S. Lyamuya,
  • Charles Kwobah,
  • John Bollinger,
  • John Bollinger,
  • John Bollinger,
  • Champica K. Bodinayake,
  • Champica K. Bodinayake,
  • Ajith Nagahawatte,
  • Ajith Nagahawatte,
  • Bhagya Piyasiri,
  • Ruvini Kurukulasooriya,
  • Shamim Ali,
  • Rose Mallya,
  • Rose Mallya,
  • Robert Rolfe,
  • Robert Rolfe,
  • Anushka Ruwanpathirana,
  • Tianchen Sheng,
  • Tianchen Sheng,
  • Truls Østbye,
  • Truls Østbye,
  • Richard Drew,
  • Richard Drew,
  • Peter Kussin,
  • Christopher W. Woods,
  • Christopher W. Woods,
  • Deverick J. Anderson,
  • Deverick J. Anderson,
  • Blandina T. Mmbaga,
  • Blandina T. Mmbaga,
  • Blandina T. Mmbaga,
  • L. Gayani Tillekeratne,
  • L. Gayani Tillekeratne,
  • L. Gayani Tillekeratne

DOI
https://doi.org/10.3389/fpubh.2022.848802
Journal volume & issue
Vol. 10

Abstract

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BackgroundTo develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and patterns of antimicrobial use in three LMIC hospitals.MethodsConsecutive patients admitted to the adult medical wards in three tertiary care hospitals in Tanzania, Kenya, and Sri Lanka were enrolled in 2018–2019. The medical record was reviewed for clinical information including type and duration of antimicrobials prescribed, indications for antimicrobial use, and microbiologic testing ordered.ResultsA total of 3,149 patients were enrolled during the study period: 1,103 from Tanzania, 750 from Kenya, and 1,296 from Sri Lanka. The majority of patients were male (1,783, 56.6% overall) with a median age of 55 years (IQR 38–68). Of enrolled patients, 1,573 (50.0%) received antimicrobials during their hospital stay: 35.4% in Tanzania, 56.5% in Kenya, and 58.6% in Sri Lanka. At each site, the most common indication for antimicrobial use was lower respiratory tract infection (LRTI; 40.2%). However, 61.0% received antimicrobials for LRTI in the absence of LRTI signs on chest radiography. Among patients receiving antimicrobials, tools to guide antimicrobial use were under-utilized: microbiologic cultures in 12.0% and microbiology consultation in 6.5%.ConclusionAntimicrobials were used in a substantial proportion of patients at tertiary care hospitals across three LMIC sites. Future ASP efforts should include improving LRTI diagnosis and treatment, developing antibiograms to direct empiric antimicrobial use, and increasing use of microbiologic tests.

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