Roll out of a successful antimicrobial stewardship programme in Lagos University Teaching Hospital Nigeria using the Global-Point Prevalence Survey

Abstract

Background: Antimicrobial resistance (AMR) has become a public health emergency with increasing rates and spread globally. Antimicrobial stewardship (AMS) has been advocated to reduce the burden of antimicrobial resistance, promote rational and appropriate use of antibiotics and improve clinical outcomes. Education and training are one of the AMS interventions to improve antimicrobial use. We present the roll out of a successful AMS programme with education and training using the Global-PPS as data collection tool to measure AMS interventions and impact.
Methodology: This was a cross sectional study on the implementation of an AMS programme at the Lagos University Teaching Hospital. Global PPS was conducted in 2015 to collect baseline data which was used to identify targets for quality improvement in AMS and was repeated in 2017 and 2018 to measure impact of AMS interventions. AMS interventions included education, feedback of Global-PPS result and writing of the hospitalwide antibiotic policy based on the baseline data.
Results: Out of the 746 inpatients surveyed, 476 (68.3%) had received at least one antimicrobial on the days of Global-PPS. The antimicrobial prescribing rates reduced significantly over the three time periods. In 2015, 82.5% were placed on antimicrobials, 65.5% in 2017 and 51.1% in 2018 (p<0.00001). The documentation of indication for treatment significantly improved from 53.4% in 2015 to 97.2% in 2018 (p<0.0001). Stop review date also significantly improved from 28.7% to 70.2% in 2018 (p<0.00001). Surgical prophylaxis for more than 24 hours reduced significantly from 93.3% in 2015 to 65.7% in 2018 (p=0.002) even though the prevalence was still high. The three most commonly administered antimicrobial groups were third generation cephalosporins, imidazole derivatives and quinolones. The most commonly prescribed antibiotics for surgical prophylaxis were ceftriaxone and metronidazole in 2015 and ceftriaxone in 2017.
Conclusion: The use of education and training as AMS intervention in a limited resource setting clearly made impact on antimicrobial prescribing patterns in the hospital. Global-PPS is useful to set quality improvement targets and for monitoring, evaluation and surveillance of an AMS programme.

Keywords: Antibiotic, Stewardship, Resistance, Education, Global-PPS