The Journal of hospital infection · 2025
Determinants of the change in empiric antibiotic therapy upon receipt of microbiological data: results from a nationwide antibiotic resistance and use surveillance programme in Madagascar, the TSARA project.
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Elias C, Rasoanandrasana S, Raherinandrasana A H, Andriananja V, Razanakolona P, Randria M, Raberahona M, Raskine L, Vanhems P, Babin F-X
Аннотация
OBJECTIVES: The overuse of antibiotics is a primary driver of resistance development, particularly in low-resource settings such as Madagascar where broad-spectrum antibiotic use is excessive. The objective was to identify factors that could influence changes to the initial antibiotic regimen upon receipt of the microbiological results in Malagasy hospitals.
METHODS: This study was part of the TSARA antibiotic resistance surveillance system implemented in eight hospitals in Madagascar belonging to the RESAMAD (Réseau des Laboratoires à Madagascar) network. The outcome was the change in the spectrum or the discontinuation of the empiric antibiotic regimen upon receiving the laboratory results.
RESULTS: Across the eight participating hospitals, 793 patients were included and the majority of the antibiotic regimens were broad-spectrum (78.8%) which were prescribed in 208 (99.1%) of 210 blood samples. Third-generation cephalosporins were most common (441, 32.1%), with ceftriaxone being the most frequently used antibiotic (421, 30.6%). Upon the receipt of the laboratory results, 21 (2.6%) patients had their empiric antibiotic therapy changed and 530 (66.8%) stopped. A total of 269 (33.9%) patients had positive cultures, with 105 (13.3%) infected by multi-drug-resistant bacteria - primarily third-generation cephalosporin-resistant Enterobacterales. The use of ≥3 empiric antibiotics mainly ceftriaxone, gentamicin, and metronidazole, increased the likelihood of discontinuation (adjusted odds ratio (aOR) = 2.85, P<0.001). Conversely, the availability of antibiotics susceptibility test results decreased the odds of antibiotic discontinuation (aOR = 0.37, P=0.004).
CONCLUSION: This study based in the TSARA surveillance system in Madagascar highlights the influence of clinical factors and microbiological data on antibiotic therapy adjustments. Broad-spectrum antibiotics were widely used as empiric treatment. Availability of the microbiological results decreased the odds of antibiotic discontinuation.
METHODS: This study was part of the TSARA antibiotic resistance surveillance system implemented in eight hospitals in Madagascar belonging to the RESAMAD (Réseau des Laboratoires à Madagascar) network. The outcome was the change in the spectrum or the discontinuation of the empiric antibiotic regimen upon receiving the laboratory results.
RESULTS: Across the eight participating hospitals, 793 patients were included and the majority of the antibiotic regimens were broad-spectrum (78.8%) which were prescribed in 208 (99.1%) of 210 blood samples. Third-generation cephalosporins were most common (441, 32.1%), with ceftriaxone being the most frequently used antibiotic (421, 30.6%). Upon the receipt of the laboratory results, 21 (2.6%) patients had their empiric antibiotic therapy changed and 530 (66.8%) stopped. A total of 269 (33.9%) patients had positive cultures, with 105 (13.3%) infected by multi-drug-resistant bacteria - primarily third-generation cephalosporin-resistant Enterobacterales. The use of ≥3 empiric antibiotics mainly ceftriaxone, gentamicin, and metronidazole, increased the likelihood of discontinuation (adjusted odds ratio (aOR) = 2.85, P<0.001). Conversely, the availability of antibiotics susceptibility test results decreased the odds of antibiotic discontinuation (aOR = 0.37, P=0.004).
CONCLUSION: This study based in the TSARA surveillance system in Madagascar highlights the influence of clinical factors and microbiological data on antibiotic therapy adjustments. Broad-spectrum antibiotics were widely used as empiric treatment. Availability of the microbiological results decreased the odds of antibiotic discontinuation.