USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda.
Department of Global Health, University of Washington, Seattle, Washington, USA.
BMJ Open Qual. 2023 Jun;12(2). doi: 10.1136/bmjoq-2023-002293.
Appropriate antimicrobial use is essential for antimicrobial stewardship (AMS). Ugandan hospitals are making efforts to improve antibiotic use, but improvements have not been sufficiently documented and evaluated.
Six Ugandan hospitals implemented AMS interventions between June 2019 and July 2022. We used the WHO AMS toolkit to set-up hospital AMS programmes and implemented interventions using continuous quality improvement (CQI) techniques and targeting conditions commonly associated with antibiotic misuse, that is, urinary tract infections (UTIs), upper respiratory tract infections (URTIs) and surgical antibiotic prophylaxis (SAP). The interventions included training, mentorship and provision of clinical guidelines to support clinical decision-making. Quarterly antibiotic use surveys were conducted.
Data were collected for 7037 patients diagnosed with UTIs. There was an increase in the proportion of patients receiving one antibiotic for the treatment of UTI from 48% during the pre-intervention to 73.2%, p<0.01. There was a 19.2% reduction in the number of antimicrobials per patient treated for UTI p<0.01. There was an increase in use of nitrofurantoin, the first-line drug for the management of UTI. There was an increase in the use of Access antibiotics for managing UTIs from 50.4% to 53.8%. The proportion of patients receiving no antimicrobials for URTI increased from 26.3% at pre-intervention compared with 53.4% at intervention phase, p<0.01. There was a 20.7% reduction in the mean number of antimicrobials per patient for URTI from the pre-intervention to the intervention phase, from 0.8 to 0.6, respectively, p<0.001 and reduction in the number of treatment days, p=0.0163. Among patients undergoing surgery, 49.5% (2212) received SAP during the pre-intervention versus 50.5% (2169) during the intervention.
Using CQI approaches to focus on specific causes of inappropriate antibiotic use led to desirable overall reductions in antibiotic use for URTI and UTI.
适当的抗菌药物使用对于抗菌药物管理（AMS）至关重要。乌干达的医院正在努力改善抗生素的使用情况，但改进情况尚未得到充分记录和评估。
六家乌干达医院在 2019 年 6 月至 2022 年 7 月期间实施了 AMS 干预措施。我们使用世界卫生组织 AMS 工具包来建立医院 AMS 计划，并使用持续质量改进（CQI）技术和针对与抗生素滥用相关的常见条件，即尿路感染（UTI）、上呼吸道感染（URTI）和外科抗生素预防（SAP）来实施干预措施。干预措施包括培训、指导和提供临床指南以支持临床决策。每季度进行一次抗生素使用调查。
共收集了 7037 名 UTI 患者的数据。接受一种抗生素治疗 UTI 的患者比例从干预前的 48%增加到 73.2%，p<0.01。接受 UTI 治疗的患者人均抗生素使用量减少了 19.2%，p<0.01。治疗 UTI 的一线药物呋喃妥因的使用有所增加。用于治疗 UTI 的 Access 抗生素的使用有所增加，从干预前的 50.4%增加到 53.8%。接受 URTI 治疗的患者无需接受抗生素治疗的比例从干预前的 26.3%增加到干预阶段的 53.4%，p<0.01。接受 URTI 治疗的患者人均抗生素使用量从干预前的 0.8 种减少到干预后的 0.6 种，降幅为 20.7%，p<0.001，治疗天数也减少，p=0.0163。在接受手术的患者中，干预前有 49.5%（2212 人）接受了 SAP，而干预期间有 50.5%（2169 人）接受了 SAP。
使用 CQI 方法专注于导致抗生素使用不合理的具体原因，导致 URTI 和 UTI 的抗生素总体使用量有所减少。
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