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Opportunities and barriers to implementing antimicrobial stewardship in low-resource settings: lessons from a mixed-methods study in a tertiary care hospital in Ethiopia

P1722 Opportunities and barriers to implementing antimicrobial stewardship in low-
resource settings: lessons from a mixed-methods study in a tertiary care hospital in
Ethiopia
Gebremedhin Beeedemariam Gebretekle1, Damen Haile Mariam2, Workeabeba Abebe
Taye3, Admasu Tenna Mamuye3, Wondewossen Amogne Degu3, Teferi Gedif1, Michael
Libman4, Cedric Yansouni4, Makeda Semret*4
1School of Pharmacy, Addis Ababa University, Ethiopia, 2School of Public Health, Addis Ababa
University, Ethiopia, 3School of Medicine, Addis Ababa University, Ethiopia, 4McGill University Health
Centre, J.D.MacLean Centre for Tropical Diseases and division of Infectious Diseases, Montreal,
Canada
Background: Global action plans to tackle antimicrobial resistance (AMR) include implementation of
antimicrobial stewardship (AMS), but few studies have directly addressed challenges faced by low-
resource settings (LRS). Our aim was to explore healthcare providers’ knowledge and perceptions on
AMR, and barriers/facilitators to successful implementation of a pharmacist-led AMS intervention in
Ethiopia.
Materials/methods: Tikur Anbessa Specialized Hospital is a 700-bed tertiary center in Addis Ababa,
and the site of an ongoing 4-year study on AMR. Between May and July 2017, using a mixed
approach of quantitative and qualitative methods, we performed a cross-sectional survey of
pharmacists and physicians using a pre-tested questionnaire and semi-structured interviews of
purposively selected respondents until thematic saturation. Differences in proportions of agreement
between physicians and pharmacists was examined using χ2 and fisher exact tests. Qualitative data
was analyzed thematically.
Results: A total of 406 survey respondents (358 physicians, 48 pharmacists), and 35 interviewees (21
physicians and 14 pharmacists) were enrolled. The majority (>90%) strongly agreed with statements
regarding the global scope of AMR, the need for stewardship, surveillance and education, but their
perceptions on factors contributing to AMR and their knowledge of institutional resistance profiles for
common bacteria, were less uniform. Close to 60% stated that most S. aureus infections were caused
by methicillin-resistant strains (an incorrect statement), and only 48% agreed that a large proportion of
gram-negative infections were caused by cephalosporin-resistant bacteria (which is true). Differences
were noted between physicians and pharmacists: more pharmacists agreed with statements on links
between broad-spectrum antibiotics and AMR (p<0.022), but physicians were more aware that lack of
diagnostic tests led to antibiotic overuse (p<0.01). Cost and availability of antibiotics were more
important considerations than microbiological results for physicians. All respondents identified high-
turnover of pharmacists and the historical lack of interdisciplinary team work as potential challenges,
but the existing hierarchical culture and academic setting were touted as opportunities to implement
AMS in Ethiopiaease copy and paste the corresponding text here
Conclusions: Knowledge and perceptions surveys are helpful to identify educational priorities and
implementation strategies for AMS, particularly in LRS where expertise and infrastructure might be
lacking.
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