{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:57:51Z","timestamp":1785499071343,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Merck Investigators Studies Program","award":["57055"],"award-info":[{"award-number":["57055"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT\/1000 PD) of penicillin (p = 0.02), aminoglycoside (p &lt; 0.001), and cephalosporin (p = 0.04). Increases in DOT\/1000 PD at post-intervention were significant for metronidazole (p &lt; 0.001), quinolone (p = 0.01), and other antibiotics (p &lt; 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p &lt; 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p &lt; 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p &lt; 0.001), de-escalation (p &lt; 0.001), accurate documentation (p &lt; 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p &lt; 0.001) and after diagnoses (p &lt; 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal.<\/jats:p>","DOI":"10.3390\/antibiotics9120914","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T09:21:15Z","timestamp":1608110475000},"page":"914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-4964","authenticated-orcid":false,"given":"Varidhi","family":"Nauriyal","sequence":"first","affiliation":[{"name":"Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar Man","family":"Rai","sequence":"additional","affiliation":[{"name":"Kirtipur Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh Dhoj","family":"Joshi","sequence":"additional","affiliation":[{"name":"Kathmandu Model Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buddhi Bahadur","family":"Thapa","sequence":"additional","affiliation":[{"name":"Pokhara Academy of Health Science, Pokhara 33700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Kaljee","sequence":"additional","affiliation":[{"name":"Global Health Initiative, Henry Ford Health System, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Prentiss","sequence":"additional","affiliation":[{"name":"Global Health Initiative, Henry Ford Health System, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Maki","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basudha","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Kathmandu Model Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak C.","family":"Bajracharya","sequence":"additional","affiliation":[{"name":"Group for Technical Assistance, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6039-8909","authenticated-orcid":false,"given":"Kshitij","family":"Karki","sequence":"additional","affiliation":[{"name":"Group for Technical Assistance, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilesh","family":"Joshi","sequence":"additional","affiliation":[{"name":"Group for Technical Assistance, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Acharya","sequence":"additional","affiliation":[{"name":"Pokhara Academy of Health Science, Pokhara 33700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laxman","family":"Banstola","sequence":"additional","affiliation":[{"name":"Pokhara Academy of Health Science, Pokhara 33700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh Raj","family":"Poudel","sequence":"additional","affiliation":[{"name":"Pokhara Academy of Health Science, Pokhara 33700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anip","family":"Joshi","sequence":"additional","affiliation":[{"name":"Pokhara Academy of Health Science, Pokhara 33700, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhinav","family":"Dahal","sequence":"additional","affiliation":[{"name":"Kathmandu Model Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niranjan","family":"Palikhe","sequence":"additional","affiliation":[{"name":"Kathmandu Model Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sachin","family":"Khadka","sequence":"additional","affiliation":[{"name":"Kathmandu Model Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Giri","sequence":"additional","affiliation":[{"name":"Kirtipur Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apar","family":"Lamichhane","sequence":"additional","affiliation":[{"name":"Kirtipur Hospital, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Zervos","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Henry Ford Health System, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/S0140-6736(10)61458-4","article-title":"Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis","volume":"377","author":"Allegranzi","year":"2011","journal-title":"Lancet"},{"key":"ref_2","first-page":"CD003543","article-title":"Interventions to improve antibiotic prescribing practices for hospital inpatients","volume":"4","author":"Davey","year":"2005","journal-title":"Cochrane Database Syst. 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Inform."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/9\/12\/914\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:45:53Z","timestamp":1760179553000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/9\/12\/914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,16]]},"references-count":21,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["antibiotics9120914"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics9120914","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,16]]}}}