Report highlights barriers to hospital stewardship in LMICs

Interviews with clinicians at hospitals in three low- and middle-income countries highlight some of the barriers to appropriate antibiotic prescribing in these settings, according to a study published yesterday in Antimicrobial Resistance & Infection Control.

For the study, an international team led by researchers with Duke Global Health Institute conducted interviews with 45 physicians at three tertiary care centers in Sri Lanka (22), Kenya (12), and Tanzania (11). The interviews assessed knowledge of antimicrobial resistance and antimicrobial stewardship programs (ASPs), current antimicrobial prescribing practices, access to diagnostics, receptiveness to ASPs, and perceived barriers to ASPs.

The interviews revealed that limited antimicrobial availability and the prohibitive cost of antimicrobials, limited diagnostic capabilities and a lack of trust in microbiologic data, and a lack of prior knowledge of ASPs were among the most frequently cited barriers to appropriate antimicrobial prescribing.

Many physicians at all three sites had not heard of ASPs before the interviews. In addition, physicians also cited limited awareness of local antimicrobial resistance patterns and reluctance to change local clinical practice customs regarding antimicrobial prescribing as barriers to implementing ASPs.

To improve antimicrobial prescribing in these settings, interviewees recommended creating hospital-specific guidelines, providing education to physicians on appropriate prescribing, and developing multidisciplinary, physician-led ASP teams.
Mar 25 Antimicrob Resist Infect Control study

European healthcare survey: AMR knowledge, practice diverge

A survey of European healthcare workers found a high level of knowledge about antibiotic use and the connection to antibiotic resistance, but that knowledge doesn’t always translate into practice, European researchers reported yesterday in Eurosurveillance.

Among the 18,365 healthcare workers from 30 European Union/European Economic Area (EU/EEA) countries who responded to the 43-item questionnaire in 2019, 96% agreed with the statement “I know what antibiotic resistance is,” and 80% agreed with the statement “I have sufficient knowledge about how to use antibiotics appropriately for my current practice.”

In addition, more than 80% correctly answered six of seven knowledge test statements, such as “antibiotics are effective against viruses” and “unnecessary use of antibiotics makes them become ineffective.” But overall, only 58% answered all seven questions correctly.

The survey also found a wide variation in the percentage of respondents answering all seven questions correctly across the 30 EU/EEA countries (40% in Estonia to 73% in Croatia) and across healthcare professions (29% of other healthcare workers to 68% of physicians). And the percentage of respondents correctly answering questions on environmental and animal health factors and hand hygiene was lower. 

In addition, fewer respondents (68%) agreed they had easy access to materials for advising patients about prudent antibiotics or had good opportunities to provide advice about antibiotic use to patients (72%), while only 63% agreed that they have a key role in helping control antibiotic use.

Of the 65% of respondents who had prescribed or dispensed antibiotics at least once in the week prior to completing the survey, only 17% had given resources (leaflets or pamphlets), and only 55% had provided advice on prudent antibiotic use.

Thirty-one percent of prescribers said they would have preferred not to prescribe an antibiotic at least once in the week before completing the survey but did so anyway.

“It is important to move from raising awareness about prudent antibiotic use and antibiotic resistance among healthcare workers to designing antimicrobial stewardship interventions aimed at changing relevant behaviours,” the study authors concluded.
Mar 25 Eurosurveill study

Study finds resistance in outpatient UTIs varies by age, sex

An analysis of antibiotic susceptibility testing in outpatient settings in Washington state found that age and sex were linked to differences in resistance patterns in urinary tract infections (UTIs) involving Escherichia coli, a team based at the University of Washington School of Public health reported today in Clinical Infectious Diseases.

The scientists based their findings on outpatient urinary E coli isolates that were tested at a clinical reference lab from 2013 to 2017. The analysis included a patient’s first UTI with E coli and included isolates from 24,215 patients over 5 years. For both males and females, most samples were from patients older than 50 years.

Among the variations in resistance pattern by age and sex, E coli in samples from women older than 50 were more likely than those in female patients younger than 19 to show resistance to amoxicillin-clavulanate, ciprofloxacin, ceftriaxone, and gentamicin. For males, men older than 50 were more likely than men and boys younger than 19 to have resistance to ciprofloxacin, but lower odds of resistance to amoxicillin-clavulanate.

The authors said that antibiotic resistance data from outpatient settings, given that antibiograms aren’t often available, could be useful in guiding empiric prescribing for treating UTIs and for supporting antibiotic stewardship efforts.
Mar 26 Clin Infect Dis abstract