RESUMO
Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p < 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p < 0.001), quinolone (p = 0.01), and other antibiotics (p < 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p < 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p < 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p < 0.001), de-escalation (p < 0.001), accurate documentation (p < 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p < 0.001) and after diagnoses (p < 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.
RESUMO
PURPOSE: This study has attempted to assess the profile and treatment outcome of patients with OSSN and report the recurrence rate following treatment of primary OSSN. MATERIALS AND METHODS: This was a retrospective, non-comparative hospital based observational study. The case files of OSSN patients from Jan 2010 to Dec 2017were assessed. The study site was Himalaya Eye Hospital, Gharipatan, Pokhara. This hospital is the only eye hospital in province 4, Nepal. All the files of suspicious cases of conjunctival mass or OSSN were reviewed. Data regarding demographic characteristics, vision acuity, involved eye, clinical features, conjunctival lesion type, duration of symptoms, preoperative clinical diagnosis, history, other eye disease, associated systemic diseases, occupation as well as treatment modalities of the patients and its outcome were taken. RESULTS: Out of 40 cases, females were 21(52.5%) vesus 19(47.5%) male. Amongthem, 19 patients had keratinized stratified squamous epithelium, 17 had conjunctiva intraepithelial squamous neoplasia and 4 had invasive squalors cell carcinoma. Predominance age group was 15-59 age (25/40, 62.5%), among which 12 had keratinized stratified squamous epithelium, 11 conjunctival intraepithelial squamousneoplasia and 2 had invasive squamous cell carcinoma conjunctival lesion. The mean duration of symptoms was about nine months (S.D. = 5.972). The mean size of lesion mass was 3.28 mm (SD=1.569). More than half of the cases (55%, 22/40) had the mass located at nasal limbus. 95% (38/40) cases underwent lesion total excision and direct closure and 5% (2/40) underwent lesion excision followed by Amniotic Membrane grafting. Only 5% (2/40) cases, those who had undergone lesion excision, the lesion recurrence was observed during follow up period of 31 months. CONCLUSION: The outcome of the OSSN following the treatment was found to be satisfactory. Further studies with prolonged follow-up are recommended to evaluate the risk of recurrence and other adverse effects.