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Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi.


ABSTRACT: Background: Third-generation cephalosporins (3GC) remain the first-choice empiric antibiotic for severe infection in many sub-Saharan African hospitals. In Malawi, the limited availability of alternatives means that strategies to prevent the spread of 3GC resistance are imperative; however, suitable approaches to antimicrobial stewardship (AMS) in low-income settings are not well studied.

Methods: We introduced an AMS intervention to Queen Elizabeth Central Hospital in Blantyre. The intervention consisted of a prescribing application for smartphones and regular point-prevalence surveys with prescriber feedback. We evaluate the effects of the intervention on 3GC usage and on the cost of providing antibiotics. Using a thematic analysis of semi-structured interviews and participant observations, we additionally evaluate the acceptability of the stewardship program.

Results: The proportion of antibiotic prescriptions for a 3GC reduced from 193/241 (80.1%) to 177/330 (53.6%; percentage decrease, 26.5%; 95% confidence interval, 18.7-34.1) with no change in the case-fatality rate. The cost analysis estimated an annual savings of US$15?000. Qualitative research revealed trust in the guideline and found that its accessibility through smartphones helpful to guide clinical decisions. Operational health-system barriers and hierarchal clinical relationships lead to continued reliance on 3GC.

Conclusions: We report the successful introduction of an antimicrobial stewardship approach in Malawi. By focusing on pragmatic interventions and simple aims, we demonstrate the feasibility, acceptability, and cost savings of a stewardship program where resources are limited. In doing so, we provide a suitable starting point for expansions of AMS interventions in this and other low-income settings.

SUBMITTER: Lester R 

PROVIDER: S-EPMC7713689 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi.

Lester Rebecca R   Haigh Kate K   Wood Alasdair A   MacPherson Eleanor E EE   Maheswaran Hendramoorthy H   Bogue Patrick P   Hanger Sofia S   Kalizang'oma Akuzike A   Srirathan Vinothan V   Kulapani David D   Mallewa Jane J   Nyirenda Mulinda M   Jewell Christopher P CP   Heyderman Robert R   Gordon Melita M   Lalloo David G DG   Tolhurst Rachel R   Feasey Nicholas A NA  

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20201201 9


<h4>Background</h4>Third-generation cephalosporins (3GC) remain the first-choice empiric antibiotic for severe infection in many sub-Saharan African hospitals. In Malawi, the limited availability of alternatives means that strategies to prevent the spread of 3GC resistance are imperative; however, suitable approaches to antimicrobial stewardship (AMS) in low-income settings are not well studied.<h4>Methods</h4>We introduced an AMS intervention to Queen Elizabeth Central Hospital in Blantyre. The  ...[more]

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