Standardizing Antimicrobial Use in a Resource-Limited Pediatric Surgical Unit in Botswana

Area of Science:

• Public Health
• Infectious Diseases
• Pediatric Surgery

Background:

• Antimicrobial resistance is a critical issue in low- and middle-income countries.
• Princess Marina Hospital (PMH) in Botswana reported inappropriate antimicrobial use in 100% of pediatric surgical patients.
• This highlights an urgent need for interventions to optimize antimicrobial prescribing practices.

Purpose of the Study:

• To implement and evaluate a quality improvement initiative aimed at enhancing antimicrobial use in pediatric surgical patients.
• To standardize antimicrobial prescribing through the development and implementation of clinical pathways (CPs).
• To assess the impact of CPs on appropriate antimicrobial utilization based on World Health Organization (WHO) guidelines.

Main Methods:

• Developed clinical pathways (CPs) for common surgical diagnoses, incorporating WHO Access, Watch, and Reserve (AWaRe) guidelines.
• Distributed CP booklets to healthcare providers at PMH's pediatric surgical ward.
• Conducted prospective antimicrobial use audits over one year (3 months pre-implementation, 9 months post-implementation).

Main Results:

• Appropriate antimicrobial use significantly improved across multiple surgical subspecialties (e.g., pediatrics, orthopedics, neurosurgery, ENT) post-CP implementation (P < .001).
• Improvements were observed across all provider categories (medical officers, interns, specialists) and experience levels.
• The WHO Access group constituted 72.4% and the Watch group 27.6% of prescribed antibiotic courses.

Conclusions:

• Clinical pathway implementation led to a significant increase in appropriate antimicrobial use in pediatric surgical patients.
• Sustained improvement requires expanding CPs and reinforcing antimicrobial stewardship education.
• This initiative offers a scalable model for combating antimicrobial resistance in resource-limited settings.