Ngetich Recognized as International Scholar for Antimicrobial Stewardship
Pharmacist Celia Ngetich, BPharm, Mclin Pharm, chair of the antimicrobial stewardship team (a subcommittee of the drugs and therapeutics committee) at Moi Teaching and Referral Hospital (MTRH), received the 2024 International Scholarship Award from the Pediatrics Infectious Disease Society for her exemplary work in antimicrobial stewardship in western Kenya.
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines. When antimicrobials become less effective, resistant organisms may spread, infections are harder to treat and the risk of severe illness and death increases. AMR is one of the top global public health and development threats, and is driven by misuse and overuse of antibiotics, anti-virals, anti-fungals and anti-parasitics.
The award supported Ngetich’s travel and attendance at the 13th Annual International Pediatric Antimicrobial Stewardship Conference in St. Louis, Missouri, USA, where she received recognition and provided an oral presentation of current antimicrobial stewardship efforts in Kenya and at MTRH. This award is intended to foster collaboration with colleagues in low- and middle-income settings doing work in pediatric antimicrobial stewardship.
While in the U.S., Ngetich also spent time at Indiana University where she participated in hospital rounds with the adult and pediatric stewardship teams and also presented to IU clinicians on the growing threat of AMR and the importance of global partnerships to help mitigate its effects.
“Antimicrobial resistance is a global public health threat,” said Ngetich during her presentation. “It has significant economic costs and affects all countries and all regions, especially the poor ones like Kenya, and the middle- and low-income countries. Despite sub-Saharan Africa having the vast majority of infectious diseases, we lack appropriate infectious disease monitoring systems as well as capacity for antimicrobial resistance surveillance.”
The Government of Kenya published the first national action plan on containment of antimicrobial resistance in 2017; national guidelines for antimicrobial stewardship in 2020; and a handbook that set forth guidelines for using microbiological diagnostic tests in 2021.
The Pfizer Foundation awarded a multi-year grant to support the AMPATH AMR program and recently renewed their support to implement a model of improved care for infectious diseases and antimicrobial stewardship in western Kenya. The team includes physicians, pharmacists and nurses at MTRH and Indiana University.
During her presentation, Ngetich outlined the program activities occurring through the AMPATH partnership at MTRH, county hospitals, health centers and in the community. These include:
· Enhanced clinical microbiology capacity including a new laboratory building, personnel and equipment, as well as increased training and support. The number of blood cultures performed between 2020 and 2022 doubled.
· Generate reliable microbiology data through training and hiring of additional phlebotomists, establishing new MTRH policy on the collection of blood cultures before antibiotics are administered and increasing needed supplies.
· Conduct facility needs assessment including interviews with staff members to characterize attitudes and practice toward antimicrobial use and testing the quality of antibiotic samples to detect substandard or counterfeit medicine.
· Implement appropriate antimicrobial education and stewardship activities including Infectious Disease Society of America trainings for interdisciplinary groups at MTRH, empiric antimicrobial treatment guideline development, community awareness events and trainings for hundreds of healthcare workers.
· Enhance capacity for infection prevention including establishing hand hygiene champions and new handwashing stations at all entry points.
Together with the clinical microbiology laboratory at MTRH, the team also developed MTRH’s first formal antibiogram, which is a tool that can help clinicians make treatment decisions by providing a snapshot of resistance patterns for specific pathogens in different hospitals and communities. Antibiograms can be useful for designing antibiotic regimens for both community-onset and hospital-acquired infections.
Future plans include establishing an infectious disease consult service to assist with patient management and mentor clinical providers on appropriate use of antimicrobials; establishing a formal infectious disease clinical fellowship program; and developing a formal antimicrobial stewardship curriculum for county hospitals.
“We still have a lot to do. We will build on what we have to continue to improve step-by-step,” concluded Ngetich.