Dena van den Bergh1, Angeliki P Messina2, Debra A Goff3, Andriette van Jaarsveld4, Renier Coetzee5, Yolande de Wet6, Elmien Bronkhorst7, Adrian Brink8, Marc Mendelson9, Guy A Richards10, Charles Feldman11, Natalie Schellack7. 1. Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital University of Cape Town, Cape Town, South Africa. Electronic address: denavandenbergh@outlook.com. 2. Division of Pharmacy, Netcare Hospitals Ltd, Johannesburg, South Africa; Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 3. The Ohio State University Wexner Medical Center, The Ohio State University College of Pharmacy; 410 W. 10(th) Avenue, Columbus, OH 43210 USA. 4. Mediclinic Southern Africa, Stellenbosch, South Africa. 5. School of Pharmacy, Faculty of Science, University of the Western Cape, Cape Town, South Africa. 6. Clinix Health Group, Johannesburg, South Africa. 7. School of Pharmacy, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa. 8. Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape town, South Africa. 9. Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital University of Cape Town, Cape Town, South Africa. 10. Department of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 11. Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Abstract
INTRODUCTION: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. METHODS: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared. RESULTS: In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47·8% to 53·6% (confidence interval [CI] 4·1-7·5, p<0·0001), diagnostic stewardship compliance improved from 49·1% to 54·6% (CI 3·3-7·7, p<0·0001) and compliance with AS process measures from 45·3% to 51·6% (CI 4·0-8·6, p<0·0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4·4%(55/1247) vs. 3·9%(47/1217); p=0·54], median LOS or IR LOS 6·0 vs. 6·0 days (p=0·20) and 5·0 vs. 5·0 days (p=0·40). CONCLUSION: Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries.
INTRODUCTION: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. METHODS: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared. RESULTS: In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47·8% to 53·6% (confidence interval [CI] 4·1-7·5, p<0·0001), diagnostic stewardship compliance improved from 49·1% to 54·6% (CI 3·3-7·7, p<0·0001) and compliance with AS process measures from 45·3% to 51·6% (CI 4·0-8·6, p<0·0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4·4%(55/1247) vs. 3·9%(47/1217); p=0·54], median LOS or IR LOS 6·0 vs. 6·0 days (p=0·20) and 5·0 vs. 5·0 days (p=0·40). CONCLUSION: Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries.
Authors: Debra A Goff; Timothy P Gauthier; Bradley J Langford; Pavel Prusakov; Michael Ubaka Chukwuemka; Benedict C Nwomeh; Khalid A Yunis; Therese Saad; Dena van den Bergh; Maria Virginia Villegas; Nela Martinez; Andrew Morris; Diane Ashiru-Oredope; Philip Howard; Pablo J Sanchez Journal: J Am Coll Clin Pharm Date: 2022-04-17
Authors: Stephanie N Tornberg-Belanger; Doreen Rwigi; Michael Mugo; Lynnete Kitheka; Nancy Onamu; Derrick Ounga; Mame M Diakhate; Hannah E Atlas; Anna Wald; R Scott McClelland; Olusegun O Soge; Kirkby D Tickell; Samuel Kariuki; Benson O Singa; Judd L Walson; Patricia B Pavlinac Journal: PLoS Negl Trop Dis Date: 2022-03-31