- INTRODUCTION
- MATERIALS AND METHODS
- Research sites.
- Research population.
- Laboratory surveillance.
- Development of prescribing guidelines.
- Post-prescription review and feedback adaptation, physician champions, and stewardship training.
- Post-prescription review and feedback evaluation: patient chart review and physician champion logbooks.
- Data management and analysis.
- Ethics.
- RESULTS
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
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1.
Dellit TH et al. 2007. Infectious Diseases Society of American and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44: 159–177.
-
2.
Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ, 2003. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 163: 972–978.
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3.
World Health Organization, 2015. Global Action Plan on Antimicrobial Resistance .Geneva, Switzerland: WHO.
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4.
Malla S et al. 2014. The challenges and successes of implementing a sustainable antimicrobial resistance surveillance programme in Nepal. BMC Public Health 14: 269–276.
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5.
Dhakal S, Manandhar S, Shrestha B, Dhakal R, Pudasaini M, 2012. Extended spectrum beta-lactamase producing multidrug resistant urinary isolates from children visiting Kathmandu Model Hospital. Nepal Med Coll J 14: 136–141.
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6.
Gyawali S, Shandar Ravi P, Saha A, Mohan L, 2009. Study of prescription injectable drugs and intravenous fluids to inpatients in a teaching hospital in Nepal. Mcgill J Med 12: 13–20.
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7.
Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B, 2010. Drug utilization among older inpatients in a teaching hospital in western Nepal. Singapore Med J 51: 28–34.
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8.
Cosgrove SE, Patel A, Song X, Miller RE, Speck K, Banowetz A, Hadler R, Sinkowitz-Cochran RL, Cardo DM, Srinivasan A, 2007. Impact of different methods of feedback to clinicians after post-prescription antimicrobial review based on the centers for disease control and prevention’s 12 steps to prevent antimicrobial resistance among hospitalized adults. Infect Control Hosp Epidemiol 28: 641–646.
-
9.
DiDiodato G, McArthur L, Bevene J, Smieia M, Thabane L, 2016. Evaluating in the impact of an antimicrobial stewardship program on the length of stay of immune-competent adult patients admitted to a hospital ward with a diagnosis of community-acquired pneumonia: a quasi-experimental study. Am J Infect Control 44: e73–e79.
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Isenberg HD, 2004. Clinical Microbiology Procedures Handbook, 2nd edition. Washington, DC: ASM Press.
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World Health Organization, 2016. AMR & One Health. Available at: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/about-amr/one-health. Accessed August 30, 2018.
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14.
Kakkar M, Chatterjee P, Chauhan AS, Grace D, Lindahl J, Beeche A, Jing F, Chotinan S, 2018. Antimicrobial resistance in South East Asia: time to ask the right questions. Glob Health Action 11: 1483637.
-
15.
Sommanustweechai A, Tangcharoensathien V, Malathum K, Sumpradit N, Kiatying-Angsulee N, Janejai N, Jaroenpoj S, 2018. Implementating national strategies on antimicrobial resistance in Thailand: potential challenges and solutions. Public Health 157: 142–146.
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16.
Wingood G, DiClemente RJ, 2008. The ADAPT-ITT model: a novel method of adapting evidence-based HIV interventions. J Acquir Immune Defic Syndr 47 (Suppl 1): S40–S46.
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17.
Rupali P et al. 2019. Impact of an antimicrobial stewardship intervention in India: evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital. Infect Control Hosp Epidemiol 40: 512–519.
-
18.
Abrar S, Hussain S, Khan RA, Ain NU, Haider H, Riaz S, 2018. Prevalence of extended-spectrum-B-lactamase producing Enterobacteriaceae: first systematic meta analysis from Pakistan. Antimicrob Resist Infect Control 7: 26.
-
19.
Chaves NJ, Cheng AC, Runnegar N, Kirshner J, Lee T, Buising K, 2014. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 44: 568–574.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2229 | 1999 | 37 |
| Full Text Views | 657 | 11 | 0 |
| PDF Downloads | 263 | 16 | 0 |
Evaluation of a Hospital-Based Post-Prescription Review and Feedback Pilot in Kathmandu, Nepal
Rajesh Dhoj Joshi
Rajesh Dhoj Joshi
Department of Medicine, Kathmandu Model Hospital, Kathmandu, Nepal;
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Marcus Zervos
Marcus Zervos
Henry Ford Health System, Division of Infectious Disease, Detroit, Michigan;
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Linda M. Kaljee
Linda M. Kaljee
Henry Ford Global Health Initiative, Detroit, Michigan;
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Basudha Shrestha
Basudha Shrestha
Laboratory and Microbiology Division, Kathmandu Model Hospital, Kathmandu, Nepal;
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Gina Maki
Gina Maki
Henry Ford Health System, Division of Infectious Disease, Detroit, Michigan;
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Tyler Prentiss
Tyler Prentiss
Henry Ford Global Health Initiative, Detroit, Michigan;
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Deepak Bajracharya
Deepak Bajracharya
Group for Technical Assistance, Kathmandu, Nepal;
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Kshitji Karki
Kshitji Karki
Group for Technical Assistance, Kathmandu, Nepal;
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Nilesh Joshi
Nilesh Joshi
Group for Technical Assistance, Kathmandu, Nepal;
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Shankar Man Rai
Shankar Man Rai
Kirtipur Hospital, Administration, Reconstructive Surgery and Burn ICU, Kathmandu, Nepal
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Capacity building is needed in low- and middle-income countries (LMICs) to combat antimicrobial resistance (AMR). Stewardship programs such as post-prescription review and feedback (PPRF) are important components in addressing AMR. Little data are available regarding effectiveness of PPRF programs in LMIC settings. An adapted PPRF program was implemented in the medicine, surgery, and obstetrics/gynecology wards in a 125-bed hospital in Kathmandu. Seven “physician champions” were trained. Baseline and post-intervention patient chart data were analyzed for changes in days of therapy (DOT) and mean number of course days for intravenous and oral antibiotics, and for specific study antibiotics. Charts were independently reviewed to determine justification for prescribed antibiotics. Physician champions documented recommendations. Days of therapy per 1,000 patient-days for courses of aminoglycoside (P < 0.001) and cephalosporin (P < 0.001) decreased. In the medicine ward, data indicate increased justified use of antibiotics (P = 0.02), de-escalation (P < 0.001), rational use of antibiotics (P < 0.01), and conforming to guidelines in the first 72 hours (P = 0.02), and for definitive therapy (P < 0.001). Physician champions documented 437 patient chart reviews and made 138 recommendations; 78.3% of recommendations were followed by the attending physician. Post-prescription review and feedback can be successfully implemented in LMIC hospitals, which often lack infectious disease specialists. Future program adaptation and training will focus on identifying additional stewardship programming and support mechanisms to optimize antibiotic use in LMICs.
Author Notes
Financial support: This work was supported by the Merck Investigators Studies Program (MISP#55020).
Authors’ addresses: Rajesh Dhoj Joshi, Department of Medicine, Kathmandu Model Hospital, Kathmandu, Nepal, E-mail: rdhojrajesh@gmail.com. Marcus Zervos and Gina Maki, Division of Infectious Disease, Henry Ford Health System, Detroit, MI, E-mails: mzervos1@hfhs.org and gmaki1@hfhs.org. Linda M. Kaljee and Tyler Prentiss, Henry Ford Global Health Initiative, Detroit, MI, E-mails: lkaljee1@hfhs.org and tprent1@hfhs.org. Basudha Shrestha, Laboratory and Microbiology Division, Kathmandu Model Hospital, Kathmandu, Nepal, E-mail: basudha111@gmail.com. Deepak Bajracharya, Kshitji Karki, and Nilesh Joshi, Group for Technical Assistance, Kathmandu, Nepal, E-mails: bajra.deepak@gmail.com, k49karki@gmail.com, and jos_nil@live.com. Shankar Man Rai, Kirtipur Hospital, Administration, Reconstructive Surgery and Burn ICU, Kathmandu, Nepal, E-mail: shankarrai1956@gmail.com.
- INTRODUCTION
- MATERIALS AND METHODS
- Research sites.
- Research population.
- Laboratory surveillance.
- Development of prescribing guidelines.
- Post-prescription review and feedback adaptation, physician champions, and stewardship training.
- Post-prescription review and feedback evaluation: patient chart review and physician champion logbooks.
- Data management and analysis.
- Ethics.
- RESULTS
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Dellit TH et al. 2007. Infectious Diseases Society of American and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44: 159–177.
-
2.
Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ, 2003. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 163: 972–978.
-
3.
World Health Organization, 2015. Global Action Plan on Antimicrobial Resistance .Geneva, Switzerland: WHO.
-
4.
Malla S et al. 2014. The challenges and successes of implementing a sustainable antimicrobial resistance surveillance programme in Nepal. BMC Public Health 14: 269–276.
-
5.
Dhakal S, Manandhar S, Shrestha B, Dhakal R, Pudasaini M, 2012. Extended spectrum beta-lactamase producing multidrug resistant urinary isolates from children visiting Kathmandu Model Hospital. Nepal Med Coll J 14: 136–141.
-
6.
Gyawali S, Shandar Ravi P, Saha A, Mohan L, 2009. Study of prescription injectable drugs and intravenous fluids to inpatients in a teaching hospital in Nepal. Mcgill J Med 12: 13–20.
-
7.
Shankar PR, Upadhyay DK, Subish P, Bhandari RB, Das B, 2010. Drug utilization among older inpatients in a teaching hospital in western Nepal. Singapore Med J 51: 28–34.
-
8.
Cosgrove SE, Patel A, Song X, Miller RE, Speck K, Banowetz A, Hadler R, Sinkowitz-Cochran RL, Cardo DM, Srinivasan A, 2007. Impact of different methods of feedback to clinicians after post-prescription antimicrobial review based on the centers for disease control and prevention’s 12 steps to prevent antimicrobial resistance among hospitalized adults. Infect Control Hosp Epidemiol 28: 641–646.
-
9.
DiDiodato G, McArthur L, Bevene J, Smieia M, Thabane L, 2016. Evaluating in the impact of an antimicrobial stewardship program on the length of stay of immune-competent adult patients admitted to a hospital ward with a diagnosis of community-acquired pneumonia: a quasi-experimental study. Am J Infect Control 44: e73–e79.
-
10.
Isenberg HD, 2004. Clinical Microbiology Procedures Handbook, 2nd edition. Washington, DC: ASM Press.
-
11.
Clinical Laboratory Standard Institute, 2014. Performance Standards for Antimicrobial Susceptibility Testing. Twenty-Fourth Informational Supplement Document, M100-S24. Wayne, PA: Clinical and Laboratory Standards Institute.
-
13.
World Health Organization, 2016. AMR & One Health. Available at: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/about-amr/one-health. Accessed August 30, 2018.
-
14.
Kakkar M, Chatterjee P, Chauhan AS, Grace D, Lindahl J, Beeche A, Jing F, Chotinan S, 2018. Antimicrobial resistance in South East Asia: time to ask the right questions. Glob Health Action 11: 1483637.
-
15.
Sommanustweechai A, Tangcharoensathien V, Malathum K, Sumpradit N, Kiatying-Angsulee N, Janejai N, Jaroenpoj S, 2018. Implementating national strategies on antimicrobial resistance in Thailand: potential challenges and solutions. Public Health 157: 142–146.
-
16.
Wingood G, DiClemente RJ, 2008. The ADAPT-ITT model: a novel method of adapting evidence-based HIV interventions. J Acquir Immune Defic Syndr 47 (Suppl 1): S40–S46.
-
17.
Rupali P et al. 2019. Impact of an antimicrobial stewardship intervention in India: evaluation of post-prescription review and feedback as a method of promoting optimal antimicrobial use in the intensive care units of a tertiary-care hospital. Infect Control Hosp Epidemiol 40: 512–519.
-
18.
Abrar S, Hussain S, Khan RA, Ain NU, Haider H, Riaz S, 2018. Prevalence of extended-spectrum-B-lactamase producing Enterobacteriaceae: first systematic meta analysis from Pakistan. Antimicrob Resist Infect Control 7: 26.
-
19.
Chaves NJ, Cheng AC, Runnegar N, Kirshner J, Lee T, Buising K, 2014. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 44: 568–574.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2229 | 1999 | 37 |
| Full Text Views | 657 | 11 | 0 |
| PDF Downloads | 263 | 16 | 0 |