| Title: |
Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study. |
| Authors: |
Aiken, Alexander M; Nyamwaya, Brian; Madrid, Lola; Edessa, Dumessa; Labi, Appiah-Korang; Obeng-Nkrumah, Noah; Mwabaya, William; Chimenya, Mabvuto; Cocker, Derek; Iregbu, Kenneth C; Princewill-Nwajiobi, Philip IP; Dramowski, Angela; Sonda, Tolbert; Mmbaga, Blandina Theophil; Ojok, David; Fwoloshi, Sombo; Scott, J Anthony G; Whitelaw, Andrew; MBIRA study collaborators |
| Publication Year: |
2024 |
| Collection: |
London School of Hygiene & Tropical Medicine: LSHTM Research Online |
| Description: |
Background: Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study. Methods: We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI). Results: Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score: median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions: median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients. Conclusions: There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
2572-4754 |
| Relation: |
https://researchonline.lshtm.ac.uk/id/eprint/4673045/1/Circumstances%20for%20treatment%20and%20control%20of%20invasive%20Enterobacterales%20infections%20in%20eight%20hospitals%20across%20sub-Saharan%20Africa.pdf; Aiken, Alexander M ORCID logo; Nyamwaya, BrianORCID logo; Madrid, LolaORCID logo; Edessa, DumessaORCID logo; Labi, Appiah-Korang; Obeng-Nkrumah, Noah; Mwabaya, William; Chimenya, Mabvuto; Cocker, DerekORCID logo; Iregbu, Kenneth C; +9 more.Princewill-Nwajiobi, Philip IPORCID logo; Dramowski, AngelaORCID logo; Sonda, Tolbert; Mmbaga, Blandina Theophil; Ojok, David; Fwoloshi, SomboORCID logo; Scott, J Anthony G ORCID logo; Whitelaw, Andrew; and MBIRA study collaborators (2024) Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study. Gates open research, 7. 21-. ISSN 2572-4754 DOI:10.12688/gatesopenres.14267.1 |
| DOI: |
10.12688/gatesopenres.14267.1 |
| Availability: |
https://researchonline.lshtm.ac.uk/id/eprint/4673045/; https://doi.org/10.12688/gatesopenres.14267.1 |
| Rights: |
cc_by_nc_nd_4 |
| Accession Number: |
edsbas.4F7E2DD1 |
| Database: |
BASE |