Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activiti...
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| Veröffentlicht in: | PloS one 2022-06, Vol.17 (6), p.e0270048-e0270048 |
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| creator | Omulo, Sylvia Oluka, Margaret Achieng, Loice Osoro, Eric Kinuthia, Rosaline Guantai, Anastasia Opanga, Sylvia Adisa Ongayo, Marion Ndegwa, Linus Verani, Jennifer R Wesangula, Eveline Nyakiba, Jarred Makori, Jones Sugut, Wilson Kwobah, Charles Osuka, Hanako Njenga, M Kariuki Call, Douglas R Palmer, Guy H VanderEnde, Daniel Luvsansharav, Ulzii-Orshikh |
| description | Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children |
| doi_str_mv | 10.1371/journal.pone.0270048 |
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We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0270048</identifier><identifier>PMID: 35709220</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Amoxicillin ; Antibiotics ; Antiinfectives and antibacterials ; Antimicrobial agents ; Biology and Life Sciences ; Catheters ; Ceftriaxone ; Central nervous system ; Control equipment ; Disease prevention ; Distribution ; Drug resistance ; Evaluation ; Health surveys ; HIV ; Hospitals ; Hospitals, Public ; Human immunodeficiency virus ; Infections ; Infectious diseases ; Medical records ; Medicine and Health Sciences ; Patients ; Pediatrics ; People and Places ; Polls & surveys ; Prescriptions ; Prevention ; Sepsis ; Surveys ; Tertiary</subject><ispartof>PloS one, 2022-06, Vol.17 (6), p.e0270048-e0270048</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication: https://creativecommons.org/publicdomain/zero/1.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-ba227f04fead95118ebd8e876faf338561c375f0824d55ba2ab9f1534d8caf773</citedby><cites>FETCH-LOGICAL-c692t-ba227f04fead95118ebd8e876faf338561c375f0824d55ba2ab9f1534d8caf773</cites><orcidid>0000-0002-1214-1092 ; 0000-0001-5679-4709 ; 0000-0002-2105-6869</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202938/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9202938/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,2096,2915,23847,27905,27906,53772,53774,79349,79350</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35709220$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Cartelle Gestal, Monica</contributor><creatorcontrib>Omulo, Sylvia</creatorcontrib><creatorcontrib>Oluka, Margaret</creatorcontrib><creatorcontrib>Achieng, Loice</creatorcontrib><creatorcontrib>Osoro, Eric</creatorcontrib><creatorcontrib>Kinuthia, Rosaline</creatorcontrib><creatorcontrib>Guantai, Anastasia</creatorcontrib><creatorcontrib>Opanga, Sylvia Adisa</creatorcontrib><creatorcontrib>Ongayo, Marion</creatorcontrib><creatorcontrib>Ndegwa, Linus</creatorcontrib><creatorcontrib>Verani, Jennifer R</creatorcontrib><creatorcontrib>Wesangula, Eveline</creatorcontrib><creatorcontrib>Nyakiba, Jarred</creatorcontrib><creatorcontrib>Makori, Jones</creatorcontrib><creatorcontrib>Sugut, Wilson</creatorcontrib><creatorcontrib>Kwobah, Charles</creatorcontrib><creatorcontrib>Osuka, Hanako</creatorcontrib><creatorcontrib>Njenga, M Kariuki</creatorcontrib><creatorcontrib>Call, Douglas R</creatorcontrib><creatorcontrib>Palmer, Guy H</creatorcontrib><creatorcontrib>VanderEnde, Daniel</creatorcontrib><creatorcontrib>Luvsansharav, Ulzii-Orshikh</creatorcontrib><title>Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.</description><subject>Amoxicillin</subject><subject>Antibiotics</subject><subject>Antiinfectives and antibacterials</subject><subject>Antimicrobial agents</subject><subject>Biology and Life Sciences</subject><subject>Catheters</subject><subject>Ceftriaxone</subject><subject>Central nervous system</subject><subject>Control equipment</subject><subject>Disease prevention</subject><subject>Distribution</subject><subject>Drug resistance</subject><subject>Evaluation</subject><subject>Health surveys</subject><subject>HIV</subject><subject>Hospitals</subject><subject>Hospitals, Public</subject><subject>Human immunodeficiency virus</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Medical records</subject><subject>Medicine and Health Sciences</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Polls & surveys</subject><subject>Prescriptions</subject><subject>Prevention</subject><subject>Sepsis</subject><subject>Surveys</subject><subject>Tertiary</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNkl1v0zAUhiMEYmPwDxBEQkJw0eKv2PEN0jTxUTFpCBi3lusct57SONhORf89Ls2mBu0C5cLx8XPe43P8FsVzjOaYCvzuxg-h0-289x3MEREIsfpBcYolJTNOEH149H9SPInxBqGK1pw_Lk5oJZAkBJ0W11-969KsD7DVLXQGyjiELexKb0vdJbd0PjlTDhFKncq0DgBlPyzbHAtgIQTdlmsfe5d0G0vXlV-g2-mnxSOb9_BsXM-K648fflx8nl1efVpcnF_ODJckzZaaEGERs6AbWWFcw7KpoRbcaktpXXFsqKgsqglrqirTeiktrihraqOtEPSseHnQ7Vsf1TiRqAiveR4I5jITiwPReH2j-uA2OuyU1079DfiwUjrkDltQVEhoBDfYYMoIYC0lt4yxKq9cNJC13o_VhuUGGgNdyu1PRKcnnVurld8qSRCRtM4Cb0aB4H8NEJPauGigbXUHftjfW4hKEMZIRl_9g97f3Uit8uMp11mf65q9qDoXSFAiBduXnd9D5a-BjTPZPtbl-CTh7SQhMwl-p5UeYlSL79_-n736OWVfH7Fr0G1aR98OyfkuTkF2AE3wMWaj3Q0ZI7V3_-001N79anR_Tntx_EB3Sbd2p38AKgH_KA</recordid><startdate>20220616</startdate><enddate>20220616</enddate><creator>Omulo, Sylvia</creator><creator>Oluka, Margaret</creator><creator>Achieng, Loice</creator><creator>Osoro, Eric</creator><creator>Kinuthia, Rosaline</creator><creator>Guantai, Anastasia</creator><creator>Opanga, Sylvia Adisa</creator><creator>Ongayo, Marion</creator><creator>Ndegwa, Linus</creator><creator>Verani, Jennifer R</creator><creator>Wesangula, Eveline</creator><creator>Nyakiba, Jarred</creator><creator>Makori, Jones</creator><creator>Sugut, Wilson</creator><creator>Kwobah, Charles</creator><creator>Osuka, Hanako</creator><creator>Njenga, M Kariuki</creator><creator>Call, Douglas R</creator><creator>Palmer, Guy H</creator><creator>VanderEnde, Daniel</creator><creator>Luvsansharav, Ulzii-Orshikh</creator><general>Public Library of Science</general><general>Public Library of Science 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survey of antibiotic use at three public referral hospitals in Kenya</title><author>Omulo, Sylvia ; Oluka, Margaret ; Achieng, Loice ; Osoro, Eric ; Kinuthia, Rosaline ; Guantai, Anastasia ; Opanga, Sylvia Adisa ; Ongayo, Marion ; Ndegwa, Linus ; Verani, Jennifer R ; Wesangula, Eveline ; Nyakiba, Jarred ; Makori, Jones ; Sugut, Wilson ; Kwobah, Charles ; Osuka, Hanako ; Njenga, M Kariuki ; Call, Douglas R ; Palmer, Guy H ; VanderEnde, Daniel ; Luvsansharav, Ulzii-Orshikh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-ba227f04fead95118ebd8e876faf338561c375f0824d55ba2ab9f1534d8caf773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Amoxicillin</topic><topic>Antibiotics</topic><topic>Antiinfectives and antibacterials</topic><topic>Antimicrobial agents</topic><topic>Biology and Life Sciences</topic><topic>Catheters</topic><topic>Ceftriaxone</topic><topic>Central 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Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Omulo, Sylvia</au><au>Oluka, Margaret</au><au>Achieng, Loice</au><au>Osoro, Eric</au><au>Kinuthia, Rosaline</au><au>Guantai, Anastasia</au><au>Opanga, Sylvia Adisa</au><au>Ongayo, Marion</au><au>Ndegwa, Linus</au><au>Verani, Jennifer R</au><au>Wesangula, Eveline</au><au>Nyakiba, Jarred</au><au>Makori, Jones</au><au>Sugut, Wilson</au><au>Kwobah, Charles</au><au>Osuka, Hanako</au><au>Njenga, M Kariuki</au><au>Call, Douglas R</au><au>Palmer, Guy H</au><au>VanderEnde, Daniel</au><au>Luvsansharav, Ulzii-Orshikh</au><au>Cartelle Gestal, Monica</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-06-16</date><risdate>2022</risdate><volume>17</volume><issue>6</issue><spage>e0270048</spage><epage>e0270048</epage><pages>e0270048-e0270048</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>35709220</pmid><doi>10.1371/journal.pone.0270048</doi><orcidid>https://orcid.org/0000-0002-1214-1092</orcidid><orcidid>https://orcid.org/0000-0001-5679-4709</orcidid><orcidid>https://orcid.org/0000-0002-2105-6869</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2022-06, Vol.17 (6), p.e0270048-e0270048 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2686270169 |
| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Amoxicillin Antibiotics Antiinfectives and antibacterials Antimicrobial agents Biology and Life Sciences Catheters Ceftriaxone Central nervous system Control equipment Disease prevention Distribution Drug resistance Evaluation Health surveys HIV Hospitals Hospitals, Public Human immunodeficiency virus Infections Infectious diseases Medical records Medicine and Health Sciences Patients Pediatrics People and Places Polls & surveys Prescriptions Prevention Sepsis Surveys Tertiary |
| title | Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya |
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