Imperial College London
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DrFelicityFitzgerald

Faculty of Medicine, Department of Infectious Disease

Senior Clinical Research Fellow
 
 
 
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Contact

 

f.fitzgerald

 
 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Chimhini:2020:10.1016/j.infpip.2020.100046,
author = {Chimhini, G and Chimhuya, S and Madzudzo, L and Heys, M and Crehan, C and Robertson, V and Ferrand, RA and Sado, B and Sharland, M and Walker, AS and Klein, N and Fitzgerald, FC},
doi = {10.1016/j.infpip.2020.100046},
journal = {Infection Prevention in Practice},
title = {Auditing use of antibiotics in Zimbabwean neonates},
url = {http://dx.doi.org/10.1016/j.infpip.2020.100046},
volume = {2},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting ∼4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. METHODS: An initial audit of admission diagnosis and antibiotic use was performed between 8th May - 6th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies 'at risk of' versus 'with' clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. RESULTS: Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P<0.0001). Re-audit after 5 months demonstrated a decrease in antibiotic prescribing at admission and discharge. Babies prescribed antibiotics at admission decreased from 449 (98%) to 96 (51%), P<0.0001. Inpatient days of therapy (DOT) reduced from 1243 to 1110/1000 patient-days. Oral amoxicillin prescription at discharge reduced from 349/354 (99%) to 1% 1/161 (P<0.0001). CONCLUSION: A substantial decrease in antibiotic use was achieved by performance feedback, training and leadership, although ongoing performance review will be key to ensuring safety and sustainability.
AU  - Chimhini,G
AU  - Chimhuya,S
AU  - Madzudzo,L
AU  - Heys,M
AU  - Crehan,C
AU  - Robertson,V
AU  - Ferrand,RA
AU  - Sado,B
AU  - Sharland,M
AU  - Walker,AS
AU  - Klein,N
AU  - Fitzgerald,FC
DO  - 10.1016/j.infpip.2020.100046
PY  - 2020///
SN  - 2590-0889
TI  - Auditing use of antibiotics in Zimbabwean neonates
T2  - Infection Prevention in Practice
UR  - http://dx.doi.org/10.1016/j.infpip.2020.100046
UR  - https://www.ncbi.nlm.nih.gov/pubmed/34368696
UR  - http://hdl.handle.net/10044/1/100034
VL  - 2
ER  -
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