Research and Innovation, Mount Kenya University, Thika, Kenya
Research and Innovation, Mount Kenya University, Thika, Kenya.
BMJ Open. 2020 Mar 31;10(3):e030823. doi: 10.1136/bmjopen-2019-030823.
Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use.
The study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs.
Approvals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.
抗菌药物耐药性（AMR）是一个全球性的日益严重的问题，特别是在撒哈拉以南非洲地区，包括肯尼亚。如果不采取任何干预措施，中低收入国家（LMICs）将受到最严重的影响，因为与高收入国家相比，这些国家的 AMR 水平已经更高，而且 LMICs 面临着更高的疾病负担。研究表明，抗菌药物的不合理使用是 AMR 的主要驱动因素。为了应对这一挑战，医院现在正在实施抗生素管理计划（ASPs），这些计划已被证明可以减少抗生素的使用，降低耐药性的流行，并带来显著的经济效益。然而，指南的实施高度依赖于实施的环境。本研究采用实施科学方法，旨在解决这一领域的知识差距，并提供在公共卫生部门使用抗生素指南和管理计划时的关键数据和实际经验。这将为 ASP 的绩效提供证据，并有可能为县、国家和地区的抗生素使用政策做出贡献。
该研究将在三个地理上不同的地区进行，每个地区由两家医院代表。在实施前阶段，将进行抗生素使用、耐药性和降级、住院时间、再入院率和成本的基线研究。干预措施，即使用抗生素指南和 ASPs，将通过逐步实施策略实施 18 个月，该策略将促进学习和持续改进管理活动，并更新指南以反映不断变化的抗生素需求。
已经从国家科学、技术和创新委员会以及肯尼亚山大学伦理审查委员会获得了进行研究的批准。这两个机构的批准被用来获得参与医院的研究许可。研究结果将提交给政策利益相关者，并在同行评议的科学期刊上发表。预计研究结果将为我们当地的适当抗生素使用指南提供信息。
