Wieters Imke, Johnstone Siobhan, Makiala-Mandanda Sheila, Poda Armel, Akoua-Koffi Chantal, Abu Sin Muna, Eckmanns Tim, Galeone Valentina, Kaboré Firmin Nongodo, Kahwata François, Leendertz Fabian H, Mputu Benoit, Ouedraogo Abdoul-Salam, Page Nicola, Schink Susanne B, Touré Fidèle Sounan, Traoré Adjaratou, Venter Marietjie, Vietor Ann Christin, Schubert Grit, Tomczyk Sara
Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
Antimicrob Resist Infect Control. 2024 Jan 25;13(1):9. doi: 10.1186/s13756-024-01365-w.
Exposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported antibiotic use in multiple sub-Saharan African countries.
ANDEMIA included 12 urban and rural health facilities in Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic, socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study enrolment were described by substance and by the WHO AWaRe classification ("Access", "Watch", "Reserve", and "Not recommended" antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual patient factors.
Among 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were reported, including 54.7% (n = 5,299) from the WHO Access antibiotic group and 44.7% (n = 4,330) from the WHO Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n = 3,071, 31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d'Ivoire urban facilities to 73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not recommended antibiotics but no Reserve antibiotics.
Reported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including further evaluation of accessibility and affordability of patient treatment.
接触抗生素已被证明是抗菌素耐药性（AMR）的驱动因素之一，在规划和实施抗击AMR的策略时，应对此加以重视。然而，撒哈拉以南非洲地区抗生素使用的数据仍然有限。我们利用来自非洲常见传染病诊断、流行病学和管理改进网络（ANDEMIA）的医院监测数据，评估了撒哈拉以南非洲多个国家自我报告的抗生素使用情况。
ANDEMIA包括科特迪瓦、布基纳法索、刚果民主共和国和南非的12个城乡卫生设施。常规纳入患有急性呼吸道感染（RTI）、急性胃肠道感染（GI）和不明原因急性发热疾病（AFDUC）的患者，并使用标准化问卷收集临床、人口统计学、社会经济和行为数据。对2018年2月至2022年5月的ANDEMIA数据进行了分析。按药物种类和世界卫生组织的AWaRe分类（“可及”、“慎用”、“储备”和“不推荐”抗生素）描述了研究入组前10天报告的抗生素使用情况。抗生素使用频率按地点、疾病综合征和个体患者因素进行分层。
在19700名ANDEMIA患者中，7258名（36.8%）报告使用了抗生素。共报告了9695种抗生素，其中54.7%（n = 5299）来自世界卫生组织的可及抗生素组，44.7%（n = 4330）来自世界卫生组织的慎用抗生素组。慎用抗生素头孢曲松是报告最多的抗生素（n = 3071，31.7%）。慎用抗生素的使用范围从科特迪瓦城市设施中RTI患者的17.4%（56/322）到布基纳法索城市设施中AFDUC患者的73.7%（630/855）。报告的抗生素使用包括世界卫生组织不推荐的抗生素，但没有储备抗生素。
这项撒哈拉以南非洲多中心研究报告的抗生素使用数据显示，世界卫生组织慎用抗生素的比例很高。在疾病综合征、国家和卫生设施地点方面发现了慎用抗生素使用的差异，这就要求采取更具针对性的抗生素使用干预措施，包括进一步评估患者治疗的可及性和可负担性。
