Kalungia Aubrey Chichonyi, Kampamba Martin, Banda David, Bambala Andrew Munkuli, Marshall Sarah, Newport Melanie, Clair-Jones Anja St, Alutuli Luke, Chambula Elias, Munsaka Lucky, Hamachila Audrey, Mwila Chiluba, Chanda Duncan, Chizimu Joseph, Chilengi Roma, Okorie Michael
Department of Pharmacy, University of Zambia, PO Box 50110, Lusaka, Zambia.
Faculty of Health Sciences, Chreso University, PO Box 37178, Lusaka, Zambia.
JAC Antimicrob Resist. 2024 Nov 5;6(6):dlae178. doi: 10.1093/jacamr/dlae178. eCollection 2024 Dec.
Antimicrobial stewardship programmes (ASPs) aim to optimize antibiotic use and prevent antimicrobial resistance.
This study assessed the impact of ASPs, initiated using a hub-and-spoke approach, on antibiotic use in Zambian public hospitals.
A pre-post study was conducted in 10 ASP-naive hospitals across Zambia using the Centers for Disease Control and Prevention (CDC)'s hospital-based ASP core elements (i.e. leadership, accountability, pharmacy expertise, stewardship actions, tracking progress, reporting and education) checklist and the global point prevalence survey methodology. The intervention involved technical staff from a national 'hub' hospital with an established ASP providing on-site orientation and mentorship to multidisciplinary teams of healthcare workers at 10 'spoke' hospitals to build capacity in antimicrobial stewardship. ASP core elements and inpatient antibiotic use prevalence (AUP) were assessed before and 12 months after ASP implementation. Data were statistically analysed.
The adoption of ASP core elements improved significantly ( = 0.001, 95% CI: -17.8 to -5.42). AUP decreased from 50.1% (±5.8, = 1477) to 44.3% (±4.6, = 1400) after 12 months, though the reduction was not statistically significant ( = 0.442; 95% CI: -9.8 to 21.6), with 'Watch' list antibiotics remaining the most commonly prescribed across the hospitals.
The hub-and-spoke approach successfully catalysed ASPs in public hospitals in Zambia, demonstrating the potential for improving antibiotic use practices over time, provided structural challenges are addressed. This approach and insights can guide stakeholders in Zambia and similar settings in enhancing hospital ASPs.
抗菌药物管理计划（ASPs）旨在优化抗生素使用并预防抗菌药物耐药性。
本研究评估了采用中心辐射方法启动的抗菌药物管理计划对赞比亚公立医院抗生素使用的影响。
在赞比亚10家未实施抗菌药物管理计划的医院开展了一项前后对照研究，采用美国疾病控制与预防中心（CDC）基于医院的抗菌药物管理计划核心要素（即领导力、问责制、药学专业知识、管理行动、跟踪进展、报告和教育）清单以及全球现患率调查方法。干预措施包括来自一家已建立抗菌药物管理计划的国家级“中心”医院的技术人员，为10家“辐条”医院的多学科医护团队提供现场指导和辅导，以增强抗菌药物管理能力。在实施抗菌药物管理计划之前和之后12个月评估抗菌药物管理计划核心要素和住院患者抗生素使用患病率（AUP）。对数据进行了统计分析。
抗菌药物管理计划核心要素的采用情况有显著改善（=0.001，95%可信区间：-17.8至-5.42）。12个月后，住院患者抗生素使用患病率从50.1%（±5.8，=1477）降至44.3%（±4.6，=1400），尽管降幅无统计学意义（=0.442；95%可信区间：-9.8至21.6），“观察”清单中的抗生素仍然是各医院最常开具的药物。
中心辐射方法成功地在赞比亚公立医院推动了抗菌药物管理计划，表明随着时间的推移，只要解决结构方面的挑战，就有可能改善抗生素使用实践。这种方法和见解可以指导赞比亚及类似环境中的利益相关者加强医院抗菌药物管理计划。
