Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews.

BACKGROUND: Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). OBJECTIVE: A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. METHODS: Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. RESULTS: Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. CONCLUSION: Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research.

Acinetobacter infections: a retrospective study to determine inhospital mortality rate and clinical factors associated with mortality.

A retrospective case series of acinetobacter infections at a tertiary hospital in Nairobi was conducted to determine the mortality rate and factors associated with mortality. Over an eight-year period, 80 clinically significant infections were identified. The majority of infections were ventilator-associated pneumonia (40%) and bloodstream infections (30%). Eighty-six percent of the isolates were multi-drug resistant. The mortality rate in the study cohort was 45%. Twelve patients grew Acinetobacter spp. within 48 h of hospitalization, and three of these patients had no prior healthcare contact. The mean Sequential Organ Failure Assessment score was associated with mortality from acinetobacter infections.

Anti-Bacterial Susceptibility Patterns of Blood Culture Isolates at a Referral Hospital in Eldoret

Background: Hospital treatment guidelines are often guided by scientific evidence of efficacy of the anti-microbial agents. In developing countries; most of the treatment guidelines are adopted from the World Health Organisation (WHO). However; local data is often needed to confirm or adjust these guidelines to suit a local situation. In resource limited settings there is scarce data on blood culture isolates and their antimicrobial sensitivity patterns to guide anti-biotic prescription in these settings.Objectives: To assess the bloodstream bacterial isolates and their anti-biotic sensitivity patterns in patients admitted at a tertiary teaching and referral hospital. Design: Hospital based laboratory retrospective study Setting: Moi Teaching and Referral Hospital (MTRH); Eldoret; Kenya. Subjects: All blood culture specimens received from inpatients at MTRH over a 12 year period from 2002 to 2013.Results: The median age was 13.4yrs (IQR 0.7-29).Most of the blood samples were from female patients (51.8%). A total of 4046 blood culture samples were analysed of which 29.9% (n=1356) yielded positive growths. Majority of the positive blood cultures were from the New Born Unit (62.4%). Staph epidermidis was the most common organism isolated (43.1% n=531) followed by Klebsiella pneumoniae (22.8% n=281). Resistance to commonly used anti-biotics (penicillin; cephalosporin) was high among gram positive as well as gram negative organisms. No trend in bacterial isolates was observed over the study period.Conclusions: Staph epidermidis and Klebsiella pneumoniae were the most common organisms isolated with higher growth rates occurring in the neonatal and paediatric age groups than in adults. There was no trend in bacterial isolates over the study period. Resistance to commonly used anti-biotics was prevalent