The purpose of this study is to conduct a comparative analysis of the consumption of antibiotics for systemic use reimbursed by the state in Kazakhstan for 2017–2019 with the Access, Watch, and Reserve classification (AWaRe 2019) of the World Health Organization (WHO). The evaluation of the consumption of antibiotics for systemic use in Kazakhstan for 2017–2019 was carried out using the ATC/DDD methodology in accordance with the WHO AWaRe classification. The study used data on all antibiotics that were centrally purchased by a single purchaser during the study period. To understand how often Access group antibiotics are taken in Kazakhstan, the top-10 most consumed antibiotics were additionally studied. The results of a comparative analysis of the antibiotics for systemic use consumption for 2017–2019 by the Access, Watch, and Reserve groups showed a negative trend of a decrease in the consumption of Access group drugs from 1.17 defined daily dose (DDDs) per 1000 inhabitants per day (DID) (39%) in 2017 to 0.59 DID (30%) in 2019. There is an increase in consumption of Watch group antibiotics from 1.84 DID (61%) in 2017 to 1.37 DID (68%) in 2019, as well as an increase in consumption of Reserve antibiotics from 0.001 DID (0.03%) to 0.4 DID (2.11%). In recent years in Kazakhstan, there has been a decrease in the consumption of Access group antibiotics. In addition, the Watch group antibiotics are widely consumed with a certain upward trend. In 2019, one Reserve antibiotic was included in the top-10 most commonly consumed antibiotics. There is a predominant consumption of parenteral forms of antibiotics for systemic use in the country.

Antimicrobial agents have a rather special position due to their importance as essential medicines for the treatment of infectious diseases. Evidence-based prescriptions are needed to optimize the use of antimicrobials in humans, as well as to decrease antimicrobial resistance. The aim of this study was to assess the inpatient consumption of antimicrobial drugs for systemic use in the period 2011–2018 in Kazakhstan. This article presents the results of an evaluation of the inpatient use of antibacterial drugs for systemic use (group J01) for the period 2011–2018 using the anatomical therapeutic chemical (ATC) classification)/defined daily dose (DDD) methodology recommended by the World Health Organization. Inpatient antimicrobial utilization is expressed as DDDs/1000 inhabitants/day (DID). The results of the assessment for inpatient antibiotic use (over an eight-year period) showed a decrease in the total consumption of antibiotics for systemic action in Kazakhstan (2011: 12.72 DID; 2018: 2.74 DID). Among oral formulations, levofloxacin was consumed the most, and cefazolin was consumed the most among the parenteral formulations of antimicrobials. The three drugs consumed the most included cefazolin (first-generation cephalosporin), ceftriaxone (third-generation cephalosporin), and cefuroxime (second-generation cephalosporin). The total consumption of antibacterials for systemic action in Kazakhstan decreased during the analyzed period, but there was an irrational use of certain groups of drugs.

Skin and soft tissue inflammatory diseases of bacterial origin occupy a significant part of hospitalizations to emergency departments. One of the most common causes of sepsis is soft tissue infection, which accounts for about a quarter of all nosocomial infections. The aim of this study was to determine the differences in microbial landscape and antibiotic susceptibility of soft tissue infection pathogens among adults and children during the period 2018–2020. We studied 110 samples of pus admitted to the Scientific Research laboratory of the Karaganda Medical University from 2018 to 2020. Each sample was studied using the standard and express methods. The antibiotic susceptibility was determined by using the diffuse disk method in accordance with the CLSI 2018 recommendations. As such, 50% of S. epidermidis strains in children and 30% in adults were methicillin resistant. Differences in the resistance of S. aureus strains in children and adults were insignificant. Thus, methicillin-resistant S. aureus (MRSA) was not detected in children, but in adults, on the other hand, their percentage was 12.5%. The third cause of infection in adults was E. coli (13.72%), among which 75% were multidrug resistant. A. baumanii was found in 4.9% of adult patients’ samples, of which 60% were multidrug resistant. The effectiveness of the most prescribed antibiotics decreased due to the isolated strain resistance.

The upper urinary tract stenting allows to restore the ureteral patency in various situations. However, one of the main disadvantages of stenting is bacterial contamination, which can be a source of persistent infections that hardly respond to antibiotic therapy. The aim of this study was to investigate the local spectrum of bacterial pathogens and their susceptibility to antibiotics in order to optimize antibacterial therapy after upper urinary tract stenting. A prospective observational study was conducted in which 140 urine samples were examined (70 before stenting and 70 after stenting). Bacterial growth was detected in 37 patients (52.8%) before stenting and in 43 patients (61.4%) after stenting. E. coli (13 (28.8%)) and Streptococcus spp. (8 (17.6%)) strains were more commonly detected before stenting; P. aeruginosa (15 (31.2%)) and E. coli (8 (16.6%)) were usually revealed after stenting. The proportion of P. aeruginosa strains after stenting grew from 4.4% up to 31.2%. E. coli strains were resistant to ampicillin (92.3% before and 100% after stenting). Three strains of E. coli (23.1%) and six strains of P. aeruginosa (40%) were multidrug-resistant. Determination of the bacterial sensitivity to antibiotics and identification of antibiotic-resistant forms of bacteria is a factor in reducing the risk of complications and optimizing antibiotic therapy during the upper urinary tract stenting.

Background: Kazakhstan inherited the Semashko health system model, known for the centralized adoption of rules at the Ministry of Health (MoH) level that regulate the healthcare system. In 2019 MoH established a national framework with indicators aimed at collecting qualitative and quantitative data from healthcare organizations as part of their annual self-evaluation, and biannual external evaluation by the National Research Center for Health Development (NRCHD). The purpose of this study was to pilot the MoH framework on rational use of medicines and evaluate its effects on medicine use practices in health care organizations and at the national level. Materials and methods: This cross-sectional study was conducted from October to December 2019 at 22 state-owned primary health care organizations (polyclinics) serving adults and children in Astana, Kazakhstan. Data were collected by trained surveyors visiting each organization. Data were converted to numeric values to arrive at compliance scores for each organization and analyzed to assess each organization’s compliance with set indicators. Results: The evaluation showed the rational use of medicines was assessed as “excellent” (90% < compliant) in 2 organizations (9% of the sample), “good” (75–89% compliant) in 7 organizations (32%), and “satisfactory” (50–74% compliant) in 13 organizations (59%), with an average compliance rate of 71% across the sample. 22 organization-specific evaluation reports were developed by the evaluator (NRCHD) and sent to health care organizations for corrective actions. Evaluation data triggered two improvements at the national level: correction of the default setting for trade names to international nonproprietary names within the physician ordering feature of the national health information system for medicines, and adoption of a national policy that allowed the exchange of unused stocks of medicines between polyclinics. Conclusions: Using the national framework allowed the evaluator agency and healthcare organizations to identify organization-specific gaps and triggered improvements in the use of medicines.

Background/Objectives: Ischemic heart disease (IHD) is a major cause of cardiovascular mortality, and emergency medical service (EMS) crews often make the first decision on whether an IHD-coded patient should be transported to hospital or managed at the scene. Evidence from Central Asian EMS systems is sparse, and it remains unclear whether routinely coded comorbidity information adds decision-relevant information beyond acute presentation. We aimed to identify predictors of the EMS hospitalization/transport decision among IHD calls in Astana, Kazakhstan. Materials and Methods: We conducted a retrospective call-level cohort study of 9985 consecutive EMS calls coded as IHD (ICD-10 I20-I25) over a five-year period. The endpoint was field disposition—hospitalization/transport versus being left at the scene—and should not be interpreted as confirmed ACS, mortality, clinical appropriateness or any other patient outcome. Group comparisons used the Mann–Whitney U and Pearson chi-square tests, and independent associations were estimated using explanatory multivariable logistic regression. Results: Overall, 2676 calls (26.8%) resulted in hospitalization/transport. The strongest independent predictors were cardiogenic shock (aOR 15.06), acute/unstable IHD versus chronic I25 (aOR 8.52) and heart failure (aOR 2.46). Other arrhythmias (aOR 1.84), atrial fibrillation (aOR 1.60), male sex (aOR 1.65) and age <45 years (aOR 1.88) were also associated with higher transport odds, whereas age ≥75 years (aOR 0.61), specialized crews (aOR 0.84) and high dispatch urgency (categories 1–2; aOR 0.84) were associated with lower odds. Model discrimination was moderate (AUC 0.69; optimism-corrected AUC 0.69), plausibly reflecting the absence of ECG findings, vital signs, symptom severity and hospital outcome data. Conclusions: The expected acuity markers dominated EMS transport decisions, but routinely coded cardiac comorbidities were independently associated with disposition in this understudied setting. The model is not deployable for individual triage; these variables should be considered candidate inputs for future models that incorporate richer clinical data, outcome linkage and prospective validation.