Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned

Abraham S Alabi; Stephen W Picka; Reubvera Sirleaf; Pacifique R Ntirenganya; Arnold Ayebare; Nidia Correa; Sarah Anyango; Gerald Ekwen; Emmanuel Agu; Rebecca Cook; John Yarngrorble; Ibrahim Sanoe; Henry Dugulu; Emmanuel Wiefue; Diana Gahn-Smith; Francis N Kateh; Ezekiel F Hallie; Christiane G Sidonie; Aaron O Aboderin; David Vassellee; Damien Bishop; Daniel Lohmann; Manja Naumann-Hustedt; Alois Dörlemann; Frieder Schaumburg

doi:10.1093/jacamr/dlac069

Implementation of an antimicrobial stewardship programme in three regional hospitals in the south-east of Liberia: lessons learned

JAC Antimicrob Resist. 2022 Jun 24;4(3):dlac069. doi: 10.1093/jacamr/dlac069. eCollection 2022 Jun.

Authors

Abraham S Alabi¹, Stephen W Picka¹, Reubvera Sirleaf¹, Pacifique R Ntirenganya², Arnold Ayebare², Nidia Correa³, Sarah Anyango², Gerald Ekwen², Emmanuel Agu⁴, Rebecca Cook², John Yarngrorble⁴, Ibrahim Sanoe⁴, Henry Dugulu⁴, Emmanuel Wiefue⁴, Diana Gahn-Smith⁴, Francis N Kateh⁴, Ezekiel F Hallie⁵, Christiane G Sidonie⁶, Aaron O Aboderin⁷, David Vassellee⁸, Damien Bishop⁸, Daniel Lohmann⁸, Manja Naumann-Hustedt¹, Alois Dörlemann¹, Frieder Schaumburg⁹

Affiliations

¹ Health Focus GmbH, Friedrich-Ebert-Straße 33, 14469 Potsdam, Germany.
² Partners In Health, Sophie Road Oldest, Congo Town, Monrovia, Liberia.
³ Partners In Health, Boston, MA, USA.
⁴ Ministry of Health, Capitol Bye-Pass, Monrovia, Liberia.
⁵ School of Pharmacy, University of Liberia, Monrovia, Liberia.
⁶ Centre de Recherches Medicales, CERMEL, Lambarene, Gabon.
⁷ Obafemi Awolowo University, Ile-Ife, Nigeria.
⁸ German Corporation for International Cooperation, GIZ, Tubman Boulevard, Congo Town, Monrovia, Liberia.
⁹ Institute of Medical Microbiology, University of Münster, Münster, Germany.

Abstract

Background: Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and middle-income countries (LMICs).

Objectives: To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals.

Methods: A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use.

Results: The majority of patients had skin and soft tissue infections (n = 108) followed by surgical site infections (n = 72), pneumonia (n = 64), urinary tract infection (n = 48) and meningitis (n = 18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, P < 0.0005), dosage (from 15.2% to 36.5%, P < 0.0005) and duration (from 13.2% to 31.0%, P < 0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P < 0.0005).

Conclusions: AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.