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Healthcare-associated infections and the prescribing of antibiotics in hospitalized patients of the Caribbean Community (CARICOM) States: a mixed-methods systematic review
Journal article   Peer reviewed

Healthcare-associated infections and the prescribing of antibiotics in hospitalized patients of the Caribbean Community (CARICOM) States: a mixed-methods systematic review

Tansy Wade, Carl Heneghan, Nia Roberts, Denice Curtis, Veronika Williams and Igho Onakpoya
Journal of Hospital Infection, Vol.110, pp.122-132
2021
DOI: https://doi.org/10.1016/j.jhin.2021.01.012
PMID: 33524426
Web of Science ID: WOS:000632342500018

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6 Times Cited - Web of Science

Abstract

Background : Healthcare-associated infections (HAI) and variation in antibiotic prescribing pose a significant public health challenge in hospitals of low-resource countries. Aim: To critically appraise and synthesize the evidence on HAI and the prescribing of antibiotics in CARICOM States. Methods: We included all primary qualitative and quantitative studies that addressed HAI, and the prescribing of antibiotics in hospitalized patients of CARICOM States. We searched Ovid MEDLINE, EMBASE, Global Health and regional databases. Risk of bias was assessed using the Mixed-methods Appraisal Tool. Findings were presented in narrative and table formats. Results: Twenty-one studies met the inclusion criteria for this mixed-methods systematic review (MMSR). Studies were from four different CARICOM States: Trinidad and Tobago, Jamaica, Haiti and Antigua and Barbuda. The ICU had the highest rate of Infections, 67% over four years. Surgical site infections were discussed by seven studies and ranged from 1.5 to 7.3%. For inpatients with contaminated or infected wounds, rates ranged from 29% to 83%. Empiric and prophylactic therapies were common and inappropriately prescribed. Resources, and training for healthcare workers in infection control and antimicrobial stewardship were insufficient. Few qualitative studies existed, so we were unable to integrate evidence from qualitative and quantitative paradigms. Conclusions: Evidence from CARICOM States show high rates of healthcare-associated infections, and inappropriately prescribed antibiotics primarily in the ICU. Disease surveillance, infection control and antimicrobial stewardship programs require urgent evidence-based improvements.

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