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Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study.
Aiken, Alexander M; Nyamwaya, Brian; Madrid, Lola; Edessa, Dumessa; Labi, Appiah-Korang; Obeng-Nkrumah, Noah; Mwabaya, William; Chimenya, Mabvuto; Cocker, Derek; Iregbu, Kenneth C; Princewill-Nwajiobi, Philip I P; Dramowski, Angela; Sonda, Tolbert; Mmbaga, Blandina Theophil; Ojok, David; Fwoloshi, Sombo; Scott, J Anthony G; Whitelaw, Andrew.
Afiliación
  • Aiken AM; Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK.
  • Nyamwaya B; KEMRI Centre for Geographic Medicine Research, Kilifi, Kenya.
  • Madrid L; Infectious Disease Epidemiology Department, London School of Hygiene and Tropical Medicine, London, UK.
  • Edessa D; School of Pharmacy, Haramaya University, Harar, Ethiopia.
  • Labi AK; Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana.
  • Obeng-Nkrumah N; Department of Medical Laboratory Sciences, University of Ghana, Accra, Ghana.
  • Mwabaya W; KEMRI Centre for Geographic Medicine Research, Kilifi, Kenya.
  • Chimenya M; Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Cocker D; Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Iregbu KC; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
  • Princewill-Nwajiobi PIP; Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria.
  • Dramowski A; Department of Medical Microbiology, National Hospital Abuja, Abuja, Nigeria.
  • Sonda T; Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
  • Mmbaga BT; Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
  • Ojok D; Kilimanjaro Clinical Research Institute-Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
  • Fwoloshi S; Department of Paediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
  • Scott JAG; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
  • Whitelaw A; Department of Medicine, University Teaching Hospital, Ministry of Health, Lusaka, Zambia.
Gates Open Res ; 7: 21, 2023.
Article en En | MEDLINE | ID: mdl-38532981
ABSTRACT

Background:

Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study.

Methods:

We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI).

Results:

Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients.

Conclusions:

There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, patient-level use reflected in-hospital drug availability, suggesting external antibiotics supply was infrequent. Antimicrobial resistant bacterial infections could plausibly show different clinical impacts across sub-Saharan Africa due to this contextual variation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Bacterianas / Sepsis Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Gates Open Res Año: 2023 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Infecciones Bacterianas / Sepsis Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Gates Open Res Año: 2023 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos