Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned.

BACKGROUND

Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs).

OBJECTIVES

To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals.

METHODS

A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use.

RESULTS

The majority of patients had skin and soft tissue infections (= 108) followed by surgical site infections (= 72), pneumonia (= 64), urinary tract infection (= 48) and meningitis (= 18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, < 0.0005), dosage (from 15.2% to 36.5%, < 0.0005) and duration (from 13.2% to 31.0%, < 0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (< 0.0005).

CONCLUSIONS

AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.