TY - JOUR
T1 - A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa
AU - South African Antibiotic Stewardship Programme Pharmacist Community-acquired Pneumonia Study Alliance
AU - van den Bergh, Dena
AU - Messina, Angeliki P.
AU - Goff, Debra A.
AU - van Jaarsveld, Andriette
AU - Coetzee, Renier
AU - de Wet, Yolande
AU - Bronkhorst, Elmien
AU - Brink, Adrian
AU - Mendelson, Marc
AU - Richards, Guy A.
AU - Feldman, Charles
AU - Schellack, Natalie
N1 - Funding Information:
South African Antibiotic Stewardship Programme Pharmacist Community-acquired Pneumonia Study Alliance. The authors would like to thank the following participating pharmacists and their respective doctors, nurses and hospital leadership for their invaluable contribution and support of this study:, Alecia Meyer13, Aleta Wege13, Amanda Bornman2, Andri de Vos2, Anette Barnard2, Anisha Chetty13, Anja Grey2, Ansune du Plessis2, Archele Truter11, Armandt Roos2, Avni Shukla2,Cahlia Naested2, Carin Whelan2, Claire Johnson15, Deon Hanse13, Desree Moonsamy2, Dhanya Mathew2, Elana Pavkovich2, Elsie Kruger5, Erica Human2, Fatima Paruk13, Fayeema Aboo2, Heide-Marie Scheepers2, Ilana Van Rensburg2, Isabel McNeil5, Izel Moolman2, Jacklyn van Dyk2, Jean Mothubatse14, Jeanine Breed5, June Manuve2, Karin Muller5, Kasavaan Naidoo2, Kim Nagoor2, Kristen Schutte2, Lecia Pienaar2, Lenny Gurie2, Leonie Mortlock2, Leonie van der Westhuizen5, Liezl Fourie2, Livonia Pillay2, Lorna Barros2, Louse Botha2, Madnieyah Salasa15, Maletje Griesel2, Mariska van der Wal5, Marlinka Cloete2, Marnette Vermeulen5, Martsu Kriel2, Meagan Rorich13, Megan Garnett2, Melissa Erasmus13, Miche Joseph13, Mimi Grobler2, Molly Erasmus2, Neeske Nel2, Pariksha Udith2, Passmore Musungwa2, Phila Dlamini7, Philemon Maanda7, Priya Naiker2, Richard Holman2, Roxanne Meyer2, Rumbidzai Chirikure2, Tarina Bester2, Tebogo Maseko7, Thato Namane7, Wilbur Asia13, Yolanda Jones2, Yolandi Thoresen2. 2Netcare Hospitals Ltd, Johannesburg, South Africa. 5Mediclinic Southern Africa, Stellenbosch, South Africa. 7Clinix Health Group, Johannesburg, South Africa. 13Western Cape Provincial Government, Department of Health, Cape Town, South Africa. 14Gauteng Provincial Government, Department of Health, Johannesburg, South Africa. We acknowledge Petra Gaylard (DMSA, Johannesburg) for her valuable contribution, comments and insights in the statistical analysis.
Funding Information:
Funding: Funding of the study was partially provided by a grant from Merck. The remaining costs were covered by volunteer contributions of time.
Publisher Copyright:
© 2020 The Authors
PY - 2020/12
Y1 - 2020/12
N2 - Introduction: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. Methods: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared. Results: In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47·8% to 53·6% (confidence interval [CI] 4·1-7·5, p<0·0001), diagnostic stewardship compliance improved from 49·1% to 54·6% (CI 3·3-7·7, p<0·0001) and compliance with AS process measures from 45·3% to 51·6% (CI 4·0-8·6, p<0·0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4·4%(55/1247) vs. 3·9%(47/1217); p=0·54], median LOS or IR LOS 6·0 vs. 6·0 days (p=0·20) and 5·0 vs. 5·0 days (p=0·40). Conclusion: Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries.
AB - Introduction: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. Methods: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and post-implementation periods were compared. Results: In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47·8% to 53·6% (confidence interval [CI] 4·1-7·5, p<0·0001), diagnostic stewardship compliance improved from 49·1% to 54·6% (CI 3·3-7·7, p<0·0001) and compliance with AS process measures from 45·3% to 51·6% (CI 4·0-8·6, p<0·0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4·4%(55/1247) vs. 3·9%(47/1217); p=0·54], median LOS or IR LOS 6·0 vs. 6·0 days (p=0·20) and 5·0 vs. 5·0 days (p=0·40). Conclusion: Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries.
KW - Antibiotic stewardship
KW - antibiotic stewardship interventions
KW - antibiotic stewardship scalability
KW - antimicrobial stewardship
KW - community-acquired pneumonia
KW - compliance
KW - cross-sector
KW - guideline adherence
KW - limited resources
KW - low-middle income country
KW - multicentre
KW - multidisciplinary
KW - pharmacist-led
KW - public and private hospitals
KW - resource constraints
KW - shared learning
KW - stewardship model
KW - upskilling
UR - http://www.scopus.com/inward/record.url?scp=85096180117&partnerID=8YFLogxK
U2 - 10.1016/j.ijantimicag.2020.106189
DO - 10.1016/j.ijantimicag.2020.106189
M3 - Article
C2 - 33045348
AN - SCOPUS:85096180117
SN - 0924-8579
VL - 56
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 6
M1 - 106189
ER -