Antimicrobial resistance and antimicrobial stewardship in South Africa: a survey of healthcare workers in academic and nonacademic hospitals

Kessendri Reddy; Yogandree Ramsamy; Khine Swe Swe-Han; Trusha Nana; Marianne Black; Molebogeng Kolojane; Vindana Chibabhai

doi:10.1017/ash.2023.483

Antimicrobial resistance and antimicrobial stewardship in South Africa: a survey of healthcare workers in academic and nonacademic hospitals

Antimicrob Steward Healthc Epidemiol. 2023 Nov 6;3(1):e202. doi: 10.1017/ash.2023.483. eCollection 2023.

Authors

Kessendri Reddy^{1

2}, Yogandree Ramsamy³, Khine Swe Swe-Han^{3

4}, Trusha Nana^{5

6}, Marianne Black^{5

6}, Molebogeng Kolojane^{5

6}, Vindana Chibabhai^{5

6}

Affiliations

¹ Division of Medical Microbiology and Immunology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
² National Health Laboratory Service Tygerberg, Cape Town, Western Cape, South Africa.
³ Department of Medical Microbiology, School of Laboratory Medicine & Medical Science, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
⁴ National Health Laboratory Service Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa.
⁵ Department of Clinical Microbiology and Infectious Diseases, School of Pathology, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
⁶ National Health Laboratory Service Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, Gauteng, South Africa.

Abstract

Objective: Antimicrobial stewardship programmes (ASPs) facilitate appropriate antimicrobial use and require contextualization for optimal functioning. We aimed to investigate perceptions of and antimicrobial resistance (AMR) and ASPs among healthcare workers in academic and nonacademic hospitals.

Design: Cross-sectional survey.

Setting: Three academic (Charlotte Maxeke Johannesburg Academic, Inkosi Albert Luthuli, Tygerberg) and three nonacademic hospitals (Leratong, Prince Mshiyeni Memorial, and Paarl) in South Africa from January to June 2022.

Participants: Doctors, nurses, and pharmacists.

Methods: Voluntary questionnaire using Google Forms, encompassing AMR, ASPs, and selected discipline-specific components.

Results: Participants comprised 79 doctors (50 academic), 178 nurses (169 academic), and 21 pharmacists (18 academic) and were female predominant. AMR was a problem in academic hospitals (74.7% vs 51.2%, p 0.004); 73.5% overall reported inappropriate antimicrobial use as a major contributor. Adequate education on antimicrobials occurred in only 36.4% overall. Microbiological testing guided therapy more often in nonacademic settings (80.0% vs 50.2%, p <0.001). In both settings, antimicrobial availability drove selection in 48.2%. Overall, ASPs improved patient care (89.8%) and reduced antimicrobial use (86.9%), although felt to override prescriber autonomy in academic settings (29.4% vs 7.5%, p 0.007), mainly among nurses. Only 50.2% reported successful local ASPs. A minority of pharmacists (20.0%) reported sufficient hospital support for ASPs. Education, involvement of infection control staff, and inclusion of nurses in ASPs were most impactful on AMR.

Conclusion: Selected healthcare worker perspectives differ by category and setting and can be targeted to improve ASPs. Further studies should target a higher number of clinical staff in both settings.