Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.
Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania.
Front Public Health. 2022 Apr 25;10:848802. doi: 10.3389/fpubh.2022.848802. eCollection 2022.
To develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and patterns of antimicrobial use in three LMIC hospitals.
Consecutive patients admitted to the adult medical wards in three tertiary care hospitals in Tanzania, Kenya, and Sri Lanka were enrolled in 2018-2019. The medical record was reviewed for clinical information including type and duration of antimicrobials prescribed, indications for antimicrobial use, and microbiologic testing ordered.
A total of 3,149 patients were enrolled during the study period: 1,103 from Tanzania, 750 from Kenya, and 1,296 from Sri Lanka. The majority of patients were male (1,783, 56.6% overall) with a median age of 55 years (IQR 38-68). Of enrolled patients, 1,573 (50.0%) received antimicrobials during their hospital stay: 35.4% in Tanzania, 56.5% in Kenya, and 58.6% in Sri Lanka. At each site, the most common indication for antimicrobial use was lower respiratory tract infection (LRTI; 40.2%). However, 61.0% received antimicrobials for LRTI in the absence of LRTI signs on chest radiography. Among patients receiving antimicrobials, tools to guide antimicrobial use were under-utilized: microbiologic cultures in 12.0% and microbiology consultation in 6.5%.
Antimicrobials were used in a substantial proportion of patients at tertiary care hospitals across three LMIC sites. Future ASP efforts should include improving LRTI diagnosis and treatment, developing antibiograms to direct empiric antimicrobial use, and increasing use of microbiologic tests.
为了为中低收入国家（LMIC）制定有效的抗菌药物管理计划（ASPs），确定改善抗菌药物使用的关键目标非常重要。我们旨在系统地描述三家 LMIC 医院中抗菌药物使用的流行情况和模式。
2018-2019 年，我们连续招募了坦桑尼亚、肯尼亚和斯里兰卡三家三级保健医院成年内科病房的住院患者。查阅病历以获取临床信息，包括所开抗菌药物的类型和持续时间、抗菌药物使用的指征以及所开的微生物学检测。
在研究期间共招募了 3149 名患者：坦桑尼亚 1103 名，肯尼亚 750 名，斯里兰卡 1296 名。大多数患者为男性（1783 名，总体占 56.6%），中位年龄为 55 岁（IQR 38-68）。在纳入的患者中，有 1573 名（50.0%）在住院期间接受了抗菌药物治疗：坦桑尼亚为 35.4%，肯尼亚为 56.5%，斯里兰卡为 58.6%。在每个地点，抗菌药物使用的最常见指征是下呼吸道感染（LRTI；40.2%）。然而，61.0%的患者在胸部 X 线片未见 LRTI 征象的情况下接受了 LRTI 的抗菌药物治疗。在接受抗菌药物治疗的患者中，指导抗菌药物使用的工具使用不足：微生物培养仅占 12.0%，微生物学咨询仅占 6.5%。
在三家 LMIC 医院的三级保健医院中，相当一部分患者使用了抗菌药物。未来的 ASP 工作应包括改善 LRTI 的诊断和治疗、制定指导经验性抗菌药物使用的药敏谱以及增加微生物学检测的使用。
