Institute of Tropical Medicine (ITM), Antwerp, Belgium; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Kimpese Health Research Center, Kimpese, Democratic Republic of Congo.
Clin Microbiol Infect. 2022 Sep;28(9):1272-1277. doi: 10.1016/j.cmi.2022.04.002. Epub 2022 Apr 18.
In the Democratic Republic of Congo and other low-resource countries, community-acquired pathogens are increasingly resistant to most locally available antibiotics. To guide efforts to optimize antibiotic use to limit antibiotic resistance, we quantified healthcare provider-specific and community-wide antibiotic use.
From household surveys, we estimated monthly healthcare visit rates by provider. From healthcare visit exit surveys, we estimated prevalence, defined daily doses, and access/watch/reserve distribution of antibiotic use by provider. Combining both, we estimated community-wide antibiotic use rates.
Of 88.7 (95% CI 81.9-95.4) healthcare visits per 1000 person-months (n = 31221), visits to private clinics (31.0, 95% CI 30.0-32.0) and primary health centres (25.5, 95% CI 24.6-26.4) were most frequent. Antibiotics were used during 64.3% (95% CI 55.2-73.5%, 162/224) of visits to private clinics, 51.1% (95% CI 45.1-57.2%, 245/469) to health centres, and 48.8% (95% CI 44.4-53.2%, 344/454) to medicine stores. Antibiotic defined daily doses per 1000 inhabitants per day varied between 1.75 (95% CI 1.02-2.39) in rural Kimpese and 10.2 (95% CI 6.00-15.4) in (peri) urban Kisantu, mostly explained by differences in healthcare utilisation (respectively 27.8 versus 105 visits per 1000 person-months), in particular of private clinics (1.23 versus 38.6 visits) where antibiotic use is more frequent. The fraction of Watch antibiotics was 30.3% (95% CI 24.6-35.9%) in private clinics, 25.6% (95% CI 20.2-31.1%) in medicine stores, and 25.1% (95% CI 19.0-31.2%) in health centres. Treatment durations <3 days were more frequent at private clinics (5.3%, 9/169) and medicine stores (4.1%, 14/338) than at primary health centres (1.8%, 5/277).
Private healthcare providers, ubiquitous in peri-urban settings, contributed most to community-wide antibiotic use and more frequently dispensed Watch antibiotics and shortened antibiotic courses. Efforts to optimize antibiotic use should include private providers at community level.
在刚果民主共和国和其他资源匮乏的国家，社区获得性病原体对大多数当地可用的抗生素的耐药性日益增强。为了指导优化抗生素使用以限制抗生素耐药性的努力，我们量化了医疗服务提供者特异性和社区范围内的抗生素使用情况。
从家庭调查中，我们估计了每个提供者的每月医疗就诊率。从医疗就诊出口调查中，我们估计了抗生素的使用频率、定义日剂量以及每个提供者的抗生素使用的获得/观察/储备分布。将两者结合起来，我们估计了社区范围内的抗生素使用率。
在每 1000 人-月（n=31221）中，有 88.7（95%置信区间 81.9-95.4）次医疗就诊，其中私人诊所（31.0，95%置信区间 30.0-32.0）和初级卫生中心（25.5，95%置信区间 24.6-26.4）就诊最频繁。在私人诊所就诊中，抗生素的使用率为 64.3%（95%置信区间 55.2-73.5%，162/224），在卫生中心就诊中为 51.1%（95%置信区间 45.1-57.2%，245/469），在药店就诊中为 48.8%（95%置信区间 44.4-53.2%，344/454）。每 1000 居民每天的抗生素定义日剂量在农村金本贝（Kimpese）为 1.75（95%置信区间 1.02-2.39），在（城郊）基桑图（Kisantu）为 10.2（95%置信区间 6.00-15.4），主要原因是医疗服务利用（分别为每 1000 人-月 27.8 和 105 次就诊）的差异，特别是私人诊所（1.23 和 38.6 次就诊）的就诊率差异较大，在私人诊所中抗生素的使用更为频繁。观察类抗生素的比例在私人诊所为 30.3%（95%置信区间 24.6-35.9%），在药店为 25.6%（95%置信区间 20.2-31.1%），在初级卫生中心为 25.1%（95%置信区间 19.0-31.2%）。在私人诊所（5.3%，9/169）和药店（4.1%，14/338）就诊的抗生素治疗疗程<3 天的情况比初级卫生中心（1.8%，5/277）更为常见。
在城郊地区普遍存在的私人医疗服务提供者，对社区范围内的抗生素使用做出了最大贡献，并且更频繁地开出观察类抗生素和缩短抗生素疗程。优化抗生素使用的努力应包括社区层面的私人提供者。
