Auditing use of antibiotics in Zimbabwean neonates
Summary: Background: Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital,...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-06-01
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| Series: | Infection Prevention in Practice |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S259008892030010X |
| _version_ | 1818435397673287680 |
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| author | G. Chimhini S. Chimhuya L. Madzudzo M. Heys C. Crehan V. Robertson R.A. Ferrand B. Sado M. Sharland A.S. Walker N. Klein F.C. Fitzgerald |
| author_facet | G. Chimhini S. Chimhuya L. Madzudzo M. Heys C. Crehan V. Robertson R.A. Ferrand B. Sado M. Sharland A.S. Walker N. Klein F.C. Fitzgerald |
| author_sort | G. Chimhini |
| collection | DOAJ |
| description | Summary: Background: Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting ∼4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. Methods: An initial audit of admission diagnosis and antibiotic use was performed between 8th May - 6th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies ‘at risk of’ versus ‘with’ clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. Results: Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P<0.0001). Re-audit after 5 months demonstrated a decrease in antibiotic prescribing at admission and discharge. Babies prescribed antibiotics at admission decreased from 449 (98%) to 96 (51%), P<0.0001. Inpatient days of therapy (DOT) reduced from 1243 to 1110/1000 patient-days. Oral amoxicillin prescription at discharge reduced from 349/354 (99%) to 1% 1/161 (P<0.0001). Conclusion: A substantial decrease in antibiotic use was achieved by performance feedback, training and leadership, although ongoing performance review will be key to ensuring safety and sustainability. Keywords: Neonatal sepsis, Low-income setting, Antibiotics, Neonatal unit, Antimicrobial stewardship, Zimbabwe |
| first_indexed | 2024-12-14T16:52:14Z |
| format | Article |
| id | doaj.art-ce27120d909c44d78666b32bdabcdf6d |
| institution | Directory Open Access Journal |
| issn | 2590-0889 |
| language | English |
| last_indexed | 2024-12-14T16:52:14Z |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Infection Prevention in Practice |
| spelling | doaj.art-ce27120d909c44d78666b32bdabcdf6d2022-12-21T22:54:02ZengElsevierInfection Prevention in Practice2590-08892020-06-0122Auditing use of antibiotics in Zimbabwean neonatesG. Chimhini0S. Chimhuya1L. Madzudzo2M. Heys3C. Crehan4V. Robertson5R.A. Ferrand6B. Sado7M. Sharland8A.S. Walker9N. Klein10F.C. Fitzgerald11Department of Paediatrics and Child Health University of Zimbabwe College of Health Sciences, Harare, Zimbabwe; Corresponding author. G Chimhini, Department of Paediatrics & Child Health, UZCHS Parirenyatwa Hospital Complex, Mazowe Street, Harare, Zimbabwe. Tel.: +263 773553471.Department of Paediatrics and Child Health University of Zimbabwe College of Health Sciences, Harare, ZimbabweDepartment of Paediatrics and Child Health University of Zimbabwe College of Health Sciences, Harare, ZimbabweUCL Great Ormond Street Institute of Child Health, University College London, London, UK; Specialist Children's and Young People's Services, East London NHS Foundation Trust, London, UKUCL Great Ormond Street Institute of Child Health, University College London, London, UKDepartment of Medical Microbiology, University of Zimbabwe College of Health Sciences, Harare, ZimbabweLondon School of Hygiene and Tropical Medicine, London, UK; Biomedical Research and Training Institute, Harare, ZimbabweMicrobiology Department Harare Central Hospital, Harare, ZimbabweSt George's University of London, London, UKMedical Research Council Clinical Trials Unit at UCL, University College London, London, UK; Nuffield Department of Medicine, Oxford University, UKUCL Great Ormond Street Institute of Child Health, University College London, London, UKUCL Great Ormond Street Institute of Child Health, University College London, London, UK; Biomedical Research and Training Institute, Harare, ZimbabweSummary: Background: Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting ∼4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. Methods: An initial audit of admission diagnosis and antibiotic use was performed between 8th May - 6th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies ‘at risk of’ versus ‘with’ clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. Results: Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P<0.0001). Re-audit after 5 months demonstrated a decrease in antibiotic prescribing at admission and discharge. Babies prescribed antibiotics at admission decreased from 449 (98%) to 96 (51%), P<0.0001. Inpatient days of therapy (DOT) reduced from 1243 to 1110/1000 patient-days. Oral amoxicillin prescription at discharge reduced from 349/354 (99%) to 1% 1/161 (P<0.0001). Conclusion: A substantial decrease in antibiotic use was achieved by performance feedback, training and leadership, although ongoing performance review will be key to ensuring safety and sustainability. Keywords: Neonatal sepsis, Low-income setting, Antibiotics, Neonatal unit, Antimicrobial stewardship, Zimbabwehttp://www.sciencedirect.com/science/article/pii/S259008892030010X |
| spellingShingle | G. Chimhini S. Chimhuya L. Madzudzo M. Heys C. Crehan V. Robertson R.A. Ferrand B. Sado M. Sharland A.S. Walker N. Klein F.C. Fitzgerald Auditing use of antibiotics in Zimbabwean neonates Infection Prevention in Practice |
| title | Auditing use of antibiotics in Zimbabwean neonates |
| title_full | Auditing use of antibiotics in Zimbabwean neonates |
| title_fullStr | Auditing use of antibiotics in Zimbabwean neonates |
| title_full_unstemmed | Auditing use of antibiotics in Zimbabwean neonates |
| title_short | Auditing use of antibiotics in Zimbabwean neonates |
| title_sort | auditing use of antibiotics in zimbabwean neonates |
| url | http://www.sciencedirect.com/science/article/pii/S259008892030010X |
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