Table 4 Antimicrobial stewardship Intervention Evaluation Studies
Publication | Duration/period of study | Location | Population type | Population Size | Theme of Stewardship intervention | Intervention description | Summary of findings | Outcome |
|---|---|---|---|---|---|---|---|---|
Sneddon, Cooper et al. [92] | – | Ghana | healthcare professionals; Nurses, Pharmacist, and Medical Doctors | 60 | Knowledge and guidelines compliance | SAPG triad approach in developing and implementing AMS using information, education and quality improvement to optimize the use of antimicrobials was adopted to teaching healthcare professionals in the hospitals. A knowledge quiz and an attitude and behaviors survey were then used to gather data before and after the training session. To ascertain the influence of the training on the knowledge and guidelines compliance | There was a significant increase in knowledge towards antimicrobial resistance and appropriate use of antibiotics from 9.4 in Keta Municipal Hospital, 9.2 in Ghana Police Hospital to 10.9 11.1 in the respective hospitals. A comparison of survey responses before and after the education sessions revealed that, it positively affected their perception of their role in Antibiotic Stewardship (AMS) and boosted their confidence in utilizing the Ghana Standard Treatment Guidelines | Improved knowledge and guideline compliance |
Ola-Bello et al. [71] | April—September 2019 | Nigeria | All children within the age group of 0–16 years on antibiotics. But the target audience were health care workers; antibiotic Prescribers | 582 | Compliance with antimicrobial guidelines, | Attending clinicians conducted daily reviews of antibiotics prescribed, considering various factors such as clinical diagnosis, choice of antibiotics, dosage, duration of therapy, clinical indications, and relevant microbiology or biomarker-based investigations. These reviews involved doctors, clinical pharmacologists, and infectious disease physicians. In cases where the initial prescription was deemed inappropriate, the reviewers provided recommendations for optimizing antimicrobial therapy in accordance with the hospital's antibiotic policy, aiming for the appropriate use of antibiotics. The interventions were then assessed based on the compliance with the recommendations | Prior to the implementation of the point prevalence survey (PPS), the prevalence of antibiotic prescribing was high, with 79.9% of patients (139 patients on admission) receiving antibiotic therapy. Out of these patients, a total of 202 antibiotic therapies were administered to 111 individuals, accounting for the high prevalence of antibiotic use. However, after the ppp was implemented, A total of 1146 antimicrobials were audited for 582 patients, of which 58.1% were appropriate therapies, 59.8% appropriate prescription in accordance to the departmental guidelines, and 40.2% were inappropriate prescriptions. There was also a significant decrease of total antibiotic prescribed for a person, as it reduced to an average prescription of 1.97 drugs | Improved compliance with antimicrobial guidelines was observed |
Alabi et al. [44] | 2019 | Liberia | Healthcare workers | 310 | quality of antimicrobial use | To evaluate the impact of a bundle of three interventions (local treatment guideline, training, and regular AMS ward rounds) on the quality of antimicrobial use, a case series was conducted. The study assessed the adherence to the local treatment guideline, completeness of microbiological diagnostics (as per the treatment guideline), and clinical outcomes as primary endpoints. The assessments were conducted before and after the implementation of AMS ward rounds | There was improved adherence to local guidelines. The utilization of suitable antimicrobials, in accordance with the guideline or laboratory reports, witnessed a notable enhancement following the AMS ward round, with the percentage increasing from 34.5% to 61.0%. The use of ceftriaxone significantly decreased from 51.3% to 14.2% after the implementation of Antibiotic Stewardship (AMS) ward rounds. Approximately 79.7% of patients had their samples sent for microbiological analysis. On Day 3, a significant improvement was observed in 92.3% of the patients | Quality of antimicrobial use was and guideline compliance improved |
Adjei et al. [37] | September 2020 to September 2021 | Ghana | Individuals aged 6 months to < 18 years of both sexes with acute febrile illness | 1512 patients were randomized to either the intervention (n = 761) or control (n = 751) group | antibiotic prescriptions | Examining the effects of incorporating rapid diagnostic tests into diagnostic algorithms on clinical outcomes and antibiotic prescriptions in comparison to standard-of-care practices | The intervention group experienced an 11% relative risk reduction in antibiotic prescription compared to the control group. Specifically, among children aged under 5 years, there was a 14% reduction, while among non-malaria patients and those with respiratory symptoms, there were reductions of 15% and 16% respectively in antibiotic prescription rates. These findings demonstrate the effectiveness of the interventions in reducing unnecessary antibiotic prescribing across various patient subgroups | The intervention had significant impact on reducing unnecessary antibiotic prescriptions |
Abubakar et al. [36] | May and December 2016 | Nigeria | All adult patients were eligible to participate in the study except HIV and cancer patients | 226 and 238 surgical procedures in the pre- and post-intervention periods respectively | Antibiotic utilization and compliance with surgical antibiotic prophylaxis | A bundle of interventions for Antibiotic Stewardship was implemented, which included educational meetings, the development of a protocol, and regular audit and feedback processes | Following the interventions, there was a notable increase in compliance with the timing of surgical antibiotic prophylaxis, rising from 14.2% to 43.3%. Similarly, compliance with the duration of prophylaxis improved from 0% to 21.8%. The interventions also had a significant impact on reducing the prescription of third-generation cephalosporin by 8.6%, redundant antibiotic use by 19.1%, and overall antibiotic utilization by 3.8 defined daily doses (DDD) per procedure | The intervention had a significant positive impact as compliance with surgical antibiotic prophylaxis and antibiotic utilization were improved |
Luedtke et al. [67] | June 1st to December 31st 2019 | Nigeria | Health care workers: surgeons and pharmacists who worked closely with surgical teams | – | Prescription behavior of surgeons and guideline compliance | A smartphone application, Gamified Antimicrobial Stewardship Decision Support App (GADSA), predesigned with features such as behavior change support system, decision support system and persuasive game techniques. It aids its users on antibiotic prescription based on standard guidelines. This is based on data the user enters into it | Following the feedback provided by the app, 12% of surgeons adjusted their decisions to align with the guidelines. Specifically, 10% of surgeons changed their decision regarding the necessity of Surgical Antibiotic Prophylaxis (SAP) to be in line with the guidelines. there was a similar pattern of change observed in decision-making related to the "type" and "duration" of SAP, with 6% and 5% of surgeons respectively making adjustments to comply with the guidelines | GADSA app has the potential to bring about substantial changes in prescribing behavior at the point of care within an African context |
Sneddon, Afriyie et al. [91] | – | Ghana | Hospital staff (medical, pharmacy, nursing and laboratory staff) | Over 100 | – | Training of hospital staff and establishing AMS teams | The assessment of the training's impact revealed a substantial positive shift in participants' understanding of antimicrobial resistance (AMR) and appropriate antibiotic utilization. It also resulted in improved attitudes and behaviours towards AMR, a better comprehension of their role in Antimicrobial Stewardship (AMS), and increased confidence in utilizing the Ghana Standard Treatment Guidelines | Training Hospital staff on AMS is a key intervention |
Enimil et al. [55] | September 2015 and 2019 | Ghana | In-patients occupying beds in September | 386 and 630 in 2015 and 2019 respectively | Antibiotic Usage and the use of markers for appropriate antibiotic prescription in the hospital | Global-PPS protocol on all inpatients; all adults, children and neonates | The incidence of hospital-acquired infections decreased from 6.2% (24/386) in 2015 to 4.8% (30/630) in 2019. The utilization of biomarkers that aid in diagnosis increased from 4.9% (12/247) to 7.6% (28/368) | Parameters or markers for appropriate antibiotic prescription improved |
Amponsah et al. [45] | November 2021 to May 2022 | Ghana | Health care staff in the hospital | – | Antibiotic use and infections management | AMS bundled stewardship programme intervention was ran on all the healthcare workers through seminars and hybrid training. Global-Point Prevalence Survey (PPS) protocol was employed in assessing antibiotics use at hospital at baseline, midpoint and end of the project | The utilization of antibiotics decreased from 65% initially to 59.7% upon completion of the project. Similarly, the prevalence of healthcare-associated infections decreased from 17.5% at the beginning to 6.5% at the conclusion. The adoption of antibiotics from the WHO Access group started at 40% but saw an increase to 50% by the end. Furthermore, the usage of watch antibiotics decreased from 60 to 50% compared to the initial assessment. In terms of culture and susceptibility testing, there was a notable increase from 111 total requests at the outset to 330 requests during the intervention period, which played a crucial role in guiding antimicrobial therapy decisions | There was a noticeable improvement in antibiotic use and the overall quality of antimicrobial therapy during the study period |
Kiemde et al. [59] | September 2020-September 2021 | Burkina Faso | Individuals presented at outpatient clinics with acute febrile disease defined as fever | 1718 | Antibiotic Prescriptions | A control and intervention procedure made of package consisting of diagnostic tool and algorithm of antibiotic prescription; to guide health workers on whether to prescribe an antibiotic or not for patients with febrile illnesses | There was no significant difference in the clinical outcomes of patients in the control and intervention arms. But the antibiotic prescription was significantly lower in the intervention arm: 40.6% versus 57.5% in the control arm | Reduce inappropriate antibiotic prescription |