Antimicrobial stewardship challenges at a referral Hospital in Western Kenya: insights from a Kakamega-Cambridge health partnership.

Objective: To identify ways of improving antimicrobial stewardship at Kakamega County Teaching and Referral Hospital (KCTRH) in western Kenya. Methods: A knowledge and awareness test was conducted among surgical ward healthcare workers to assess their understanding of how to counter antimicrobial resistance. In parallel, the global Point Prevalence Survey (PPS) was used to understand antibiotic prescription practices at the referral facility. Patient records from the adult surgical and pediatric surgical wards were examined for information on antibiotic prescription and usage. A total of 47 healthcare workers and 106 patient records were examined. Results: Healthcare workers showed the highest competence when tested on the appropriate use of antimicrobials, with a mean score of 78.7%. However, their understanding of surveillance and monitoring was lower, with a mean score of 60.2%, followed by awareness and education (which achieved a mean score of 64.5%). The majority of prescriptions (62.3%) were for empiric treatment, with a lack of laboratory data to support targeted therapies. Prolonged antibiotic courses were noted for surgical prophylaxes with over 83% of patients being administered antibiotics for more than 1 day. The survey also revealed over-prescription of broad-spectrum agents such as ceftriaxone at 36.7%. Conclusion: There is a high use of antibiotics, but a weakness in AMR monitoring at KCTRH. Better use of laboratory testing (AMR profiles for infecting bacteria, etc) is recommended as the best way to improve patient management and deployment of antibiotics.