Paving the Way for the Implementation of a Decision Support System for Antibiotic Prescribing in Primary Care in West Africa: Preimplementation and Co-Design Workshop With Physicians.

BACKGROUND: Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR). Clinical decision support systems (CDSS) can assist prescribers with rapid access to up-to-date information. In low- and middle-income countries (LMIC), the introduction of CDSS for antibiotic prescribing could have a measurable impact. However, interventions to implement them are challenging because of cultural and structural constraints, and their adoption and sustainability in routine clinical care are often limited. Preimplementation research is needed to ensure relevant adaptation and fit within the context of primary care in West Africa. OBJECTIVE: This study examined the requirements for a CDSS adapted to the context of primary care in West Africa, to analyze the barriers and facilitators of its implementation and adaptation, and to ensure co-designed solutions for its adaptation and sustainable use. METHODS: We organized a workshop in Burkina Faso in June 2019 with 47 health care professionals representing 9 West African countries and 6 medical specialties. The workshop began with a presentation of Antibioclic, a publicly funded CDSS for antibiotic prescribing in primary care that provides personalized antibiotic recommendations for 37 infectious diseases. Antibioclic is freely available on the web and as a smartphone app (iOS, Android). The presentation was followed by a roundtable discussion and completion of a questionnaire with open-ended questions by participants. Qualitative data were analyzed using thematic analysis. RESULTS: Most of the participants had access to a smartphone during their clinical consultations (35/47, 74%), but only 49% (23/47) had access to a computer and none used CDSS for antibiotic prescribing. The participants considered that CDSS could have a number of benefits including updating the knowledge of practitioners on antibiotic prescribing, improving clinical care and reducing AMR, encouraging the establishment of national guidelines, and developing surveillance capabilities in primary care. The most frequently mentioned contextual barrier to implementing a CDSS was the potential risk of increasing self-medication in West Africa, where antibiotics can be bought without a prescription. The need for the CDSS to be tailored to the local epidemiology of infectious diseases and AMR was highlighted along with the availability of diagnostic tests and antibiotics using national guidelines where available. Participants endorsed co-design involving all stakeholders, including nurses, midwives, and pharmacists, as central to any introduction of CDSS. A phased approach was suggested by initiating and evaluating CDSS at a pilot site, followed by dissemination using professional networks and social media. The lack of widespread internet access and computers could be circumvented by a mobile app with an offline mode. CONCLUSIONS: Our study provides valuable information for the development and implementation of a CDSS for antibiotic prescribing among primary care prescribers in LMICs and may, in turn, contribute to improving antibiotic use, clinical outcomes and decreasing AMR.

[Screening for 4MRGN in German emergency departments]. / Screening auf 4MRGN in deutschen Notaufnahmen.

BACKGROUND: Multiresistant Gram-negative bacteria (MRGN) are a growing clinical problem. The practical implementation of the recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) for screening according to 4MRGN (MRGN resistant to all four categories of antibiotics), however, varies considerably between emergency departments. OBJECTIVES: This study is intended to give an overview of the status quo and the quality assurance of 4MRGN screening and to show possibilities for process optimization. MATERIALS AND METHODS: In 2018, a web-based survey was conducted among emergency room directors and directors of clinics in the Association of Hospital Directors in Germany (VKD). RESULTS: The response rate of the 267 clinics surveyed was 31.1%. In all, 83.4% of the emergency rooms surveyed routinely screen for multiresistant pathogens. In 71.8% a standard procedure (SOP) is defined and 82.0% of the test criteria refer to the KRINKO recommendation. Only 39.7% of the clinics follow it without in-house adaptation. No clinic can give an exact number of actual risk patients per year. According to the median, 55 patients in an emergency room met the KRINKO screening criteria in 2017. Only 40 patients were screened for suspected 4MRGN. Quality assurance of the screening was performed by 41.0% of emergency departments. The responsibility lies mainly with the hygiene department. CONCLUSIONS: Even if screenings are carried out as far as possible, there is a lack of standardization in the recording of case numbers and quality assurance. Therefore, it can be assumed that there are numerous individuals with undetected 4MRGN. As a quality indicator, SOPs could clearly assign responsibilities and improve infection hygiene.

[Antibiotic stewardship (ABS)-strategies for urologists in private practice and hospitals]. / "Antibiotic-stewardship"(ABS)-Strategien in der urologischen Praxis und Klinik.

Antibiotics are effective and safe drugs which have saved millions of lives since their inception. The World Health organization (WHO) has identified increasing antibiotic resistance worldwide as one of the greatest health problems of our time. The most common indications for antibiotic therapy include urinary tract infections, but according to current data, a very high percentage of these are not treated in accordance with guidelines. To prevent the continuous selection of resistant bacteria, and undesirable or even dangerous side effects such as by avoiding damage to the patient's microbiome, strategies through antibiotic stewardship (ABS) are urgently needed. Especially for urologists in outpatient care, this requires new, innovative and sustainable training concepts that keep knowledge continuously up-to-date and support appropriate antibiotic prescriptions.