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Legba BB, Dougnon V, Koudokpon H, Mero S, Elovainio R, Parry M, Bankole H, Haukka K. Assessment of blood cultures and antibiotic susceptibility testing for bacterial sepsis diagnosis and utilization of results by clinicians in Benin: A qualitative study. Front Public Health 2023; 10:1088590. [PMID: 36726632 PMCID: PMC9885088 DOI: 10.3389/fpubh.2022.1088590] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives We assessed the current status of blood culture and antibiotic susceptibility testing (AST) practices in clinical laboratories in Benin, and how the laboratory results are used by physicians to prescribe antibiotics. Methods The qualitative study covered twenty-five clinical laboratories with a bacteriology unit and associated hospitals and pharmacies. Altogether 159 laboratory staff, physicians and pharmacists were interviewed about their perceptions of the state of laboratory diagnostics related to sepsis and the use of antibiotics. Face-to-face interviews based on structured questionnaires were supported by direct observations when visiting five laboratories in across the country. Results Only 6 laboratories (24%) conducted blood cultures, half of them with a maximum of 10 samples per month. The most common gram-negative bacteria isolated from blood cultures were: Escherichia coli, Salmonella spp. and Salmonella enterica serovar Typhi while the most common gram-positives were Enterococcus spp. and Staphylococcus aureus. None of the laboratories listed Klebsiella pneumoniae among the three most common bacteria isolated from blood cultures, although other evidence indicates that it is the most common cause of sepsis in Benin. Due to limited testing capacity, physicians most commonly use empirical antibiotic therapy. Conclusions More resources are needed to develop laboratory testing capacity, technical skills in bacterial identification, AST, quality assurance, and communication of results must be strengthened.
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Affiliation(s)
- Brice Boris Legba
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Victorien Dougnon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Hornel Koudokpon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Physicians for Social Responsibility, Helsinki, Finland
| | - Riku Elovainio
- Physicians for Social Responsibility, Helsinki, Finland
- Tampere Center for Child, Adolescent, and Maternal Health Research (TAMCAM): Global Health Group, University of Tampere, Tampere, Finland
| | - Matti Parry
- Physicians for Social Responsibility, Helsinki, Finland
- New Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Honoré Bankole
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Kaisa Haukka
- Physicians for Social Responsibility, Helsinki, Finland
- Department of Microbiology, University of Helsinki, Helsinki, Finland
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Brembilla A, Mauny F, Garcia A, Koura KG, Deloron P, Faucher JF. Antibiotics usage in infants during the first 18 months of life in Benin: a population-based cohort study. Eur J Clin Microbiol Infect Dis 2016; 35:681-9. [PMID: 26864042 DOI: 10.1007/s10096-016-2587-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/14/2016] [Indexed: 01/21/2023]
Abstract
Data centered on antibiotics usage and their determinants in African pediatric populations are limited. In order to define the determinants of antibiotics prescriptions (ABPr), we analyzed the data of a birth cohort in Benin. From 2007 to 2009, 538 infants were followed from birth to 18 months in three different health centers. The following determinants were assessed: infants' clinical findings at consultations, mothers' and children's characteristics at birth, and health parameters recorded at scheduled follow-up of general health parameters. Multilevel logistic models were performed for analysis. Among the 4394 consultations, fever represented 53.7 % of consultations, 64.1 % of which were non-malarial fevers. Antibiotics were prescribed during 44.2 % of the consultations and the proportion of ABPr differed significantly among health centers (p < 10(-3)). Nearly 40 % of ABPr were related to children without fever. During the first semester of life, the percentage of ABPr was twice lower than after (27.4 vs. 54.7, p < 10(-3)). Respiratory and enteric symptoms were positively associated with ABPr (p < 10(-3)). Malaria was significantly associated with a lower ABPr after the first semester [odds ratio (OR) = 0.55, 95 % confidence interval (CI) = 0.44-0.67, p < 10(-3)]. No maternal and child at-birth characteristics were associated with ABPr. ABPr was positively associated with a low breastfeeding score (p < 10(-3)). Studies on the rational use of antibiotics in this population should give priority to children more than 6 months of age, without malaria, and with respiratory and/or enteric symptoms. Our data also advocate for studies specifically designed to assess and improve healthcare providers' compliance to guidelines on antibiotics usage.
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Affiliation(s)
- A Brembilla
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 25000, Besançon, France. .,Centre de Méthodologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, 25000, Besançon, France.
| | - F Mauny
- Laboratoire Chrono-Environnement UMR CNRS 6249, Université Bourgogne Franche-Comté, 25000, Besançon, France.,Centre de Méthodologie Clinique, Centre Hospitalier Régional Universitaire de Besançon, 2 Place Saint-Jacques, 25000, Besançon, France
| | - A Garcia
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - K G Koura
- Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Paris, France
| | - P Deloron
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - J-F Faucher
- UMR 216 MERIT IRD, Paris, France.,PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
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Fadare J, Olatunya O, Oluwayemi O, Ogundare O. Drug prescribing pattern for under-fives in a paediatric clinic in South-Western Nigeria. Ethiop J Health Sci 2015; 25:73-8. [PMID: 25733787 PMCID: PMC4337085 DOI: 10.4314/ejhs.v25i1.10] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The audit of drug prescribing pattern in under-five children is essential in identifying the various types of non-rational prescribing such as polypharmacy and irrational use of antimicrobials. The primary objective of this study was to determine the drug prescribing pattern for children aged below five years attending the paediatric outpatient clinic of a tertiary hospital in Ado-Ekiti, South-West Nigeria. Methods A cross-sectional study was carried out using the medical records of patients who attended the paediatric clinic of the hospital between April 1 and October 30, 2013. The medical records of patients aged below five years were selected monthly for the period of the study using a regular interval ratio. Drug use indicators were assessed using the WHO guidelines on investigation of drug use in health care facilities. Results There were 293(55.7%) prescriptions collected from male patients and 233(44.3% from female patients with a total of 1369 prescribed drugs (2.6 ± 1.1 drugs per prescription). A total of three hundred and seventy-four (71.1%) patients had at least one antibiotic prescribed with antibiotics accounting for 28.2% of all drugs prescribed, while 13.5% of all encounters had an injection prescribed. Prescribing by generic name was done in 68.9 ± 26.5% of all prescribed medications, and 60.4% of all prescribed medications were from the latest version of the Nigerian Essential Drug List. Three hundred and twelve children (59.3%) had at least one anti-malarial drug prescribed while analgesics drugs accounted for 6.1% of all prescriptions. Conclusion This study showed that over-prescription of antibiotics, significant use of injections and prescribing by generic name are real issues among Nigerian paediatric prescribers.
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Affiliation(s)
- Joseph Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Nigeria
| | - Oladele Olatunya
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Oludare Oluwayemi
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria
| | - Olatunde Ogundare
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria
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Means AR, Weaver MR, Burnett SM, Mbonye MK, Naikoba S, McClelland RS. Correlates of inappropriate prescribing of antibiotics to patients with malaria in Uganda. PLoS One 2014; 9:e90179. [PMID: 24587264 PMCID: PMC3938663 DOI: 10.1371/journal.pone.0090179] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/27/2014] [Indexed: 11/19/2022] Open
Abstract
Background In many rural areas of Uganda, febrile patients presenting to health facilities are prescribed both antimalarials and antibiotics, contributing to the overuse of antibiotics. We identified the prevalence and correlates of inappropriate antibiotic management of patients with confirmed malaria. Methods We utilized individual outpatient data from 36 health centers from January to September 2011. We identified patients who were prescribed antibiotics without an appropriate clinical indication, as well as patients who were not prescribed antibiotics when treatment was clinically indicated. Multivariate logistic regression models were used to identify clinical and operational factors associated with inappropriate case management. Findings Of the 45,591 patients with parasitological diagnosis of malaria, 40,870 (90%) did not have a clinical indication for antibiotic treatment. Within this group, 17,152 (42%) were inappropriately prescribed antibiotics. The odds of inappropriate prescribing were higher if the patient was less than five years old (aOR 1.96, 95% CI 1.75–2.19) and if the health provider had the fewest years of training (aOR 1.86, 95% CI 1.05–3.29). The odds of inappropriate prescribing were lower if patients had emergency triage status (aOR 0.75, 95% CI 0.59–0.96) or were HIV positive (aOR 0.31, 95% CI 0.20–0.45). Of the 4,721 (10%) patients with clinical indications for antibiotic treatment, 521 (11%) were inappropriately not prescribed antibiotics. Clinical officers were less likely than medical officers to inappropriately withhold antibiotics (aOR 0.54, 95% CI 0.29–0.98). Conclusion Over 40% of the antibiotic treatment in malaria positive patients is prescribed despite a lack of documented clinical indication. In addition, over 10% of patients with malaria and a clinical indication for antibiotics do not receive them. These findings should inform facility-level trainings and interventions to optimize patient care and slow trends of rising antibiotic resistance.
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Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | - Marcia R. Weaver
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sarah M. Burnett
- Accordia Global Health Foundation, Washington DC, United States of America
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Martin K. Mbonye
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Sarah Naikoba
- Infectious Diseases Institute, Makerere College of Health Sciences, Kampala, Uganda
- Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - R. Scott McClelland
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
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