A Cross-country Audit Of Antimicrobial Prescribing In Emergency General Surgery: A Mixed-methods Analysis From The UK And Nepal

Le résumé fourni par la source

Background: Antimicrobial resistance (AMR) disproportionately affects lower-middle-income countries (LMICs) with limited stewardship infrastructure, microbiological and therapeutic options. Surgical antimicrobial stewardship (AMS) is a critical, achievable target for improving outcomes. A decade after the Lancet Commission on Global Surgery, cross-border collaboration remains vital to empower local action and elevate surgical care worldwide. Aim: To compare therapeutic antimicrobial prescribing in emergency general surgery between a UK hospital and Nepalese tertiary centre, while assessing the impact of low-cost, cross-country educational interventions to explore transferrable quality improvement strategies. Methods: A mixed retrospective-prospective audit was conducted at a UK district general hospital (pre-intervention n=102; post-intervention n=45) and Nepalese tertiary hospital (n=23). Indicators included documentation of indication, duration, 48-hour review, and compliance with local, national and World Health Organisation (WHO) guidelines. Interviews with Nepalese clinicians identified contextual AMS barriers. A joint intervention —cross-site peer-led teaching and visual prescribing aid—was implemented bilaterally. Results: Guideline compliance in the UK increased by 9% (41.2% to 51.1%), with improved documentation of duration (85.3% to 100%), indication (93.1% to 100%), and 48-hour review (48.0% to 88.9%). In Nepal, absence of formal protocols limited compliance assessment; 48-hour reviews occurred in 21.7% of cases and indication undocumented in 39.1%, though duration was always recorded. Nepalese clinicians reported strong engagement with context-adapted educational tools. Conclusion: This audit highlights disparities and shared challenges in antimicrobial prescribing. Synergistic peer-led, context adapted AMS education empowered stewardship improvements, demonstrating potential for adaptation in LMICs, combating AMR and advancing global surgical safety.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.