Antimicrobial stewardship practices in Kenyan Government and Faith-Based Referral Hospitals before and after COVID-19

Abstract

Background: Antimicrobial stewardship is essential to mitigate antimicrobial resistance. This study assessed antibiotic use in  government and faith-based referral hospitals in Kenya before and after the COVID-19 pandemic. We aimed to understand the impact of  the pandemic on antibiotic prescribing practices in these settings.

Methods: Data on patient-level antibiotic use were extracted from hospital medical records using a modified WHO point prevalence  form. A mobilefriendly online extraction form was made available through Open Data Kit software to facilitate this process.

Results: A study of 5,442 medical records found that female adults accounted for 57.41% of antibiotic recipients. The most common  reasons for antibiotic use were obstetrics/gynaecological infections (17.3%), pneumonia (15.4%), and soft tissue infections (12.4%).  Approximately 55.37% of antibiotic treatments occurred before COVID-19, with an increase afterward. The most commonly prescribed  antibiotics were ceftriaxone (34.06%) and Benzylpenicillin (14.7%), both of which were significantly associated with pre- and post- COVID-19 periods (X-squared = 789.95, df = 6, p-value < 2.2e-16). Clinicians underutilized culture and antimicrobial susceptibility tests with  approximately 95% of clinician prescriptions lacking laboratory support, and some referral hospitals were incapable of conducting  basic microbiology testing.

Conclusion: High rates of antibiotic prescribing observed across studied wards suggest potential misuse  before and after COVID-19, necessitating strengthened stewardship programmes to ensure responsible prescribing and monitoring.  Tailored treatment and equitable access to standardised guidelines are essential to combat antibiotic resistance. Insufficient demand for  laboratory tests, which contributes to antibiotic resistance, calls for investment, policies, improved communication, and enhanced  clinician education.