Antimicrobial Stewardship in Developing Countries: Evaluating Hospital-Based Interventions Against Rising Resistance

Abstract

Antimicrobial stewardship is a proven tool to improve antimicrobial use in hospitals, which is crucial to reduce the emergence and spread of resistance. Several studies have shown an increase in resistance where closures and rationalization of use have not taken place. To confront this problem, guidelines, education, and training have been developed. The impact of such interventions has been measured in terms of clinical outcomes, incidence of infection, colonization and/or bacteraemia caused by multidrug-resistant bacteria, and resistance against bacteria isolated in clinical samples. While stewardship is important in all countries, the level of resistance, infrastructure to support it, and available antimicrobials can vary worldwide and the burden of resistant infections is much higher in developing countries. These countries face greater challenges in implementation because of a lack of resources, cultural differences, and greater population densities that facilitate the spread of resistant bacteria. Data from developing countries are summarized, studies are appraised, and ways forward are proposed.

Antimicrobial stewardship is a key tool to improve antimicrobial use and reduce resistance. The evaluation of hospital-based interventions designed to address the rising problem of resistance is particularly pertinent for developing countries, where challenges in implementation are greatest. In addition to demonstrating the clinical and microbiological benefits of such interventions, future stewardship activities—also in developing countries—would greatly benefit from the exploitation of newer approaches and tools for cross-infection control and for monitoring antimicrobial consumption in hospitals.