Candida and Bacterial Skin Colonisation of Critically-ill Patients in Two Tertiary Healthcare Facilities in Zambia

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care and reducing antibiotic prescriptions in primary health care facilities.Methods: We performed a cluster randomized control trail in 40 health facilities randomized at 1:1 ratio to evaluate the impact of ePOCT + compared to usual care, and intervention on antibiotic prescription, clinical outcome and quality of care.20 facilities were in Morogoro and 20 in Mbeya regions of Tanzania.Results: Over 11 months, 23,593 consultations were enrolled in 20 ePOCT + health facilities, and 20,713 in 20 usual care facilities.In both arms, 51% were female, 82% were 2-59months old, and about 92% came for initial consultation.The most common presentations were fever, diarrhoea and respiratory symptoms.Antibiotics were prescribed in 23.2% of consultations in ePOCT + intervention facilities, and 70.1% in usual care facilities (adjusted difference, -46.4%, 95% confidence interval (CI) -57.6 to -35.2).Day 7 clinical failure in ePOCT + facilities was non-inferior to usual care facilities (adjusted relative risk 0.97, 95% CI 0.85 to 1.10) and hence despite of low antibiotic use, the cure was similar to control sites.Discussion: Without a guiding tool, there is a tendency of antibiotic overuse whereas most of the children presenting with fever receive at least one antibiotic.Our findings shows that ePOCT + provided guidance to promote anti-microbial stewardship.Conclusion: Using ePOCT + could help address the urgent problem of antimicrobial resistance by safely reducing antibiotic prescription in lower-level facilities.

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