Abstract
Nationally-devised standard treatment guidelines (STGs) for nosocomial infections were evaluated in the context of antibiotic resistance within the public health care system in Kwazulu-Natal. A multi-centre surveillance study instituted in 3 hospitals at 3 progressive levels of health care (district, regional and tertiary) collected consecutive, non-repetitive isolates commonly implicated in nosocomial infections as cited by the STGs, viz.,Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa andAcinetobacter spp. Isolates were subjected to susceptibility testing against antibiotics recommended in the treatment guidelines as empirical treatment for nosocomial infections using the Kirby Bauer disc diffusion method advocated by the CLSI. Percentage susceptibility across (1) bacterial species, (2) antibiotics and (3) hospital levels was compared. Susceptibility to antibiotics recommended in the treatment guidelines and hence potentially successful empiric therapy ranged from 5 to 95% with multi-resistance evident in all isolates. Statistically significant differences in overall susceptibility were observed (1) across bacterial species, (2) within 2 of the 3 bacterial species for different antibiotics and; (3) across hospital levels for 2 antibiotics with p values <0.001 for across bacterial species, (1), ranging from 0.003 to <0.001 for within 2 of the 3 bacterial species for different antibiotics (2) and ranging from 0.001 to <0.001 for across hospital levels for 2 antibiotics (3). This study showed that the success of empiric therapy as dictated by treatment guidelines would vary depending upon the bacterial species, the antibiotic used and the hospital, thus making a strong case for institution-specific guidelines based on evidence from well-executed surveillance. Key words: Treatment guidelines, nosocomial infections, antibiotic resistance.
Highlights
The South African National Department of Health implemented standard treatment guidelines (STGs) and an essential drugs list (EDL) for common health problems, including all infections, encountered at primary care and hospital level
This study showed that the success of empiric therapy as dictated by treatment guidelines would vary depending upon the bacterial species, the antibiotic used and the hospital, making a strong case for institution-specific guidelines based on evidence from well-executed surveillance
This study evaluated nationally-devised STGs for nosocomial infections in the context of antibiotic resistance within the public health care system in Kwazulu-Natal, South Africa
Summary
The South African National Department of Health implemented standard treatment guidelines (STGs) and an essential drugs list (EDL) for common health problems, including all infections, encountered at primary care and hospital level. STGs and the EDL are critical aspects of the national health policy devised in the process of health care transformation in South Africa; addressing major health problems, initiating equity in health care delivery (availability and accessibility of essential drugs to all citizens), and, providing for rational prescribing and dispensing (National Department of Health, 1998). Pharmacokinetic and pharmacodynamic data, drug interactions, adverse effects, routes of administration, concentrations at anatomical sites and cost are considered in the development of STGs and the EDL. This study evaluated nationally-devised STGs for nosocomial infections in the context of antibiotic resistance within the public health care system in Kwazulu-Natal, South Africa The vacillating nature of antimicrobial susceptibility often nullifies such factors in the development of STGs for infections (Blondeau and Tillotson, 1999).
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