1. A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa.
- Author
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van den Bergh, Dena, Messina, Angeliki P., Goff, Debra A., van Jaarsveld, Andriette, Coetzee, Renier, de Wet, Yolande, Bronkhorst, Elmien, Brink, Adrian, Mendelson, Marc, Richards, Guy A, Feldman, Charles, and Schellack, Natalie
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ANTIMICROBIAL stewardship , *COMMUNITY-acquired pneumonia , *PUBLIC hospitals , *GUIDELINES , *COMPLIANCE auditing - Abstract
• Frontline stewards in different settings can collaborate in coordinated interventions to accelerate antibiotic stewardship. • Upskilling existing resources and interdisciplinary engagement enables antibiotic stewardship across health systems. • Community-acquired pneumonia stewardship intervention across public and private hospitals in low-middle income country. • Improved diagnostic stewardship and antibiotic stewardship compliance with no difference between public and private hospitals. • Strengthening scalability of antibiotic stewardship programs in LMICs may benefit from the methodology of shared learning. Introduction: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. Methods: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared. Results: In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47·8% to 53·6% (confidence interval [CI] 4·1-7·5, p<0·0001), diagnostic stewardship compliance improved from 49·1% to 54·6% (CI 3·3-7·7, p<0·0001) and compliance with AS process measures from 45·3% to 51·6% (CI 4·0-8·6, p<0·0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4·4%(55/1247) vs. 3·9%(47/1217); p=0·54], median LOS or IR LOS 6·0 vs. 6·0 days (p=0·20) and 5·0 vs. 5·0 days (p=0·40). Conclusion: Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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