Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal
Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in th...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-12-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/12/914 |
| _version_ | 1797544475017347072 |
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| author | Varidhi Nauriyal Shankar Man Rai Rajesh Dhoj Joshi Buddhi Bahadur Thapa Linda Kaljee Tyler Prentiss Gina Maki Basudha Shrestha Deepak C. Bajracharya Kshitij Karki Nilesh Joshi Arjun Acharya Laxman Banstola Suresh Raj Poudel Anip Joshi Abhinav Dahal Niranjan Palikhe Sachin Khadka Piyush Giri Apar Lamichhane Marcus Zervos |
| author_facet | Varidhi Nauriyal Shankar Man Rai Rajesh Dhoj Joshi Buddhi Bahadur Thapa Linda Kaljee Tyler Prentiss Gina Maki Basudha Shrestha Deepak C. Bajracharya Kshitij Karki Nilesh Joshi Arjun Acharya Laxman Banstola Suresh Raj Poudel Anip Joshi Abhinav Dahal Niranjan Palikhe Sachin Khadka Piyush Giri Apar Lamichhane Marcus Zervos |
| author_sort | Varidhi Nauriyal |
| collection | DOAJ |
| description | Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (<i>p</i> = 0.02), aminoglycoside (<i>p</i> < 0.001), and cephalosporin (<i>p</i> = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (<i>p</i> < 0.001), quinolone (<i>p</i> = 0.01), and other antibiotics (<i>p</i> < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (<i>p</i> < 0.001) and Pokhara Academy of Health Sciences (<i>p</i> = 0.02), but not at Kathmandu Model Hospital (<i>p</i> = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (<i>t</i> = 3.56; <i>p</i> < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (<i>p</i> < 0.001), de-escalation (<i>p</i> < 0.001), accurate documentation (<i>p</i> < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (<i>p</i> < 0.001) and after diagnoses (<i>p</i> < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal. |
| first_indexed | 2024-03-10T14:02:02Z |
| format | Article |
| id | doaj.art-642ce565d85b4338a893fd6aacc2c947 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T14:02:02Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-642ce565d85b4338a893fd6aacc2c9472023-11-21T01:04:29ZengMDPI AGAntibiotics2079-63822020-12-0191291410.3390/antibiotics9120914Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in NepalVaridhi Nauriyal0Shankar Man Rai1Rajesh Dhoj Joshi2Buddhi Bahadur Thapa3Linda Kaljee4Tyler Prentiss5Gina Maki6Basudha Shrestha7Deepak C. Bajracharya8Kshitij Karki9Nilesh Joshi10Arjun Acharya11Laxman Banstola12Suresh Raj Poudel13Anip Joshi14Abhinav Dahal15Niranjan Palikhe16Sachin Khadka17Piyush Giri18Apar Lamichhane19Marcus Zervos20Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USAKirtipur Hospital, Kathmandu 44600, NepalKathmandu Model Hospital, Kathmandu 44600, NepalPokhara Academy of Health Science, Pokhara 33700, NepalGlobal Health Initiative, Henry Ford Health System, Detroit, MI 48202, USAGlobal Health Initiative, Henry Ford Health System, Detroit, MI 48202, USADivision of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USAKathmandu Model Hospital, Kathmandu 44600, NepalGroup for Technical Assistance, Kathmandu 44600, NepalGroup for Technical Assistance, Kathmandu 44600, NepalGroup for Technical Assistance, Kathmandu 44600, NepalPokhara Academy of Health Science, Pokhara 33700, NepalPokhara Academy of Health Science, Pokhara 33700, NepalPokhara Academy of Health Science, Pokhara 33700, NepalPokhara Academy of Health Science, Pokhara 33700, NepalKathmandu Model Hospital, Kathmandu 44600, NepalKathmandu Model Hospital, Kathmandu 44600, NepalKathmandu Model Hospital, Kathmandu 44600, NepalKirtipur Hospital, Kathmandu 44600, NepalKirtipur Hospital, Kathmandu 44600, NepalDivision of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USAAntimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (<i>p</i> = 0.02), aminoglycoside (<i>p</i> < 0.001), and cephalosporin (<i>p</i> = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (<i>p</i> < 0.001), quinolone (<i>p</i> = 0.01), and other antibiotics (<i>p</i> < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (<i>p</i> < 0.001) and Pokhara Academy of Health Sciences (<i>p</i> = 0.02), but not at Kathmandu Model Hospital (<i>p</i> = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (<i>t</i> = 3.56; <i>p</i> < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (<i>p</i> < 0.001), de-escalation (<i>p</i> < 0.001), accurate documentation (<i>p</i> < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (<i>p</i> < 0.001) and after diagnoses (<i>p</i> < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.https://www.mdpi.com/2079-6382/9/12/914antibiotic resistancestewardshipwound careburn careNepal |
| spellingShingle | Varidhi Nauriyal Shankar Man Rai Rajesh Dhoj Joshi Buddhi Bahadur Thapa Linda Kaljee Tyler Prentiss Gina Maki Basudha Shrestha Deepak C. Bajracharya Kshitij Karki Nilesh Joshi Arjun Acharya Laxman Banstola Suresh Raj Poudel Anip Joshi Abhinav Dahal Niranjan Palikhe Sachin Khadka Piyush Giri Apar Lamichhane Marcus Zervos Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal Antibiotics antibiotic resistance stewardship wound care burn care Nepal |
| title | Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal |
| title_full | Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal |
| title_fullStr | Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal |
| title_full_unstemmed | Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal |
| title_short | Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal |
| title_sort | evaluation of an antimicrobial stewardship program for wound and burn care in three hospitals in nepal |
| topic | antibiotic resistance stewardship wound care burn care Nepal |
| url | https://www.mdpi.com/2079-6382/9/12/914 |
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