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Akintan P, Oshun P, Osuagwu C, Ola-Bello O, Fajolu I, Roberts A, Temiye E, Oduyebo O. Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country-the impact of an antimicrobial stewardship program. BMC Pediatr 2024; 24:383. [PMID: 38834956 DOI: 10.1186/s12887-024-04847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Resistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital. METHOD A point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis ( http://www.global-pps.com ). RESULTS A total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%. CONCLUSION The indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.
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Affiliation(s)
- Patricia Akintan
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria.
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Philip Oshun
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chioma Osuagwu
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olafoyekemi Ola-Bello
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Iretiola Fajolu
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Alero Roberts
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Edamisan Temiye
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Oyinlola Oduyebo
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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Boltena MT, Wolde M, Hailu B, El-Khatib Z, Steck V, Woldegerima S, Siraneh Y, Morankar S. Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:12652. [PMID: 38825623 PMCID: PMC11144712 DOI: 10.1038/s41598-024-62651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.
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Affiliation(s)
- Minyahil Tadesse Boltena
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Mirkuzie Wolde
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- University of Technology Sydney, Sydney, Australia
| | - Belachew Hailu
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Ziad El-Khatib
- Global Public Health Department, Karolinska Institute, Solna, Sweden
| | - Veronika Steck
- Department of Pharmacology and Therapeutics, Faculty of Life Sciences, McGill University, Montreal, Canada
| | - Selam Woldegerima
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yibeltal Siraneh
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Abubakar U, Salman M. Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies. J Racial Ethn Health Disparities 2024; 11:1308-1329. [PMID: 37157014 PMCID: PMC10166031 DOI: 10.1007/s40615-023-01610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa. METHODS Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles. RESULTS Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4-83.5%) and North Africa (79.1%) compared to East Africa (27.6-73.7%) and South Africa (33.6-49.7%). The ICU (64.4-100%; n = 9 studies) and the pediatric medical ward (10.6-94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7-61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6-45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4-51.7%; n = 14 studies), metronidazole (14.6-44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6-22.3%), and ampicillin (n = 6 studies; range: 6.0-29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3-97.9%, 1.8-53.5%, and 0.0-5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively. CONCLUSION The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
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Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Loong LS, Tg Abu Bakar Sidik TMI, Ramli R, Tan TL, Kori N, Yin MK, Azman NJ, James R, Thursky K, Naina Mohamed I. Assessment of antimicrobial prescribing patterns, guidelines compliance, and appropriateness of antimicrobial prescribing in surgical-practice units: point prevalence survey in Malaysian teaching hospitals. Front Pharmacol 2024; 15:1381843. [PMID: 38720771 PMCID: PMC11076853 DOI: 10.3389/fphar.2024.1381843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: This study sought to investigate the quality of antimicrobial prescribing among adult surgical inpatients besides exploring the determinants of non-compliance and inappropriate prescribing to inform stewardship activities. Methods: A cross-sectional point prevalence study employing Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) was conducted in April 2019 at two teaching hospitals in Malaysia. Results: Among 566 surgical inpatients, 44.2% were receiving at least one antimicrobial, for a total of 339 prescriptions. Antimicrobials belonging to the World Health Organization's Watch group were observed in 57.8% of cases. Both hospitals exhibited similar types of antimicrobial treatments prescribed and administration routes. A significant difference in antimicrobial choice was observed between hospitals (p < 0.001). Hospital with electronic prescribing demonstrated better documentation practice (p < 0.001). Guidelines compliance, 32.8% (p = 0.952) and appropriateness, 55.2% (p = 0.561) did not significantly differ. The major contributors of inappropriateness were incorrect duration, (15%) and unnecessary broad-spectrum coverage, (15.6%). Non-compliance and inappropriate prescribing were found to be 2 to 4 times significantly higher with antimicrobial prophylaxis prescription compared to empirical therapy. Conclusion: Antimicrobial stewardship efforts to improve appropriate surgical prescribing are essential. These initiatives should prioritize surgical prophylaxis prescribing, focusing on reducing unnecessarily prolonged use and broad-spectrum antimicrobials, raising awareness among prescribers and promoting proper documentation.
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Affiliation(s)
- Nurul Adilla Hayat Jamaluddin
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Hospital and Clinical Pharmacy, Faculty of Pharmacy, University of Cyberjaya, Cyberjaya, Selangor, Malaysia
| | - Petrick Periyasamy
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chee Lan Lau
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | | | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- School of Medical and Life Sciences, Sunway University, Petaling Jaya, Selangor, Malaysia
| | - Ly Sia Loong
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tg Mohd Ikhwan Tg Abu Bakar Sidik
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ramliza Ramli
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Toh Leong Tan
- Emergency Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Najma Kori
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mei Kuen Yin
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Nur Jannah Azman
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia
| | - Rodney James
- The Royal Melbourne Hospital, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
| | - Karin Thursky
- The Royal Melbourne Hospital, Melbourne, Australia
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
| | - Isa Naina Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Ruef M, Emonet S, Merglen A, Dewez JE, Obama BM, Catho G, Andrey DO, Kowalski M, Harbarth S, Combescure C, Wagner N, Galetto-Lacour A. Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102508. [PMID: 38500839 PMCID: PMC10945212 DOI: 10.1016/j.eclinm.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Background The increasing resistance of Enterobacterales to third-generation cephalosporins and carbapenems in sub-Saharan Africa (SSA) is a major public health concern. We did a systematic review and meta-analysis of studies to estimate the carriage prevalence of Enterobacterales not susceptible to third-generation cephalosporins or carbapenems among paediatric populations in SSA. Methods We performed a systematic literature review and meta-analysis of cross-sectional and cohort studies to estimate the prevalence of childhood (0-18 years old) carriage of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) or carbapenem-resistant Enterobacterales (CRE) in SSA. Medline, EMBASE and the Cochrane Library were searched for studies published from 1 January 2005 to 1 June 2022. Studies with <10 occurrences per bacteria, case reports, and meta-analyses were excluded. Quality and risk of bias were assessed using the Newcastle-Ottawa scale. Meta-analyses of prevalences and odds ratios were calculated using generalised linear mixed-effects models. Heterogeneity was assessed using I2 statistics. The protocol is available on PROSPERO (CRD42021260157). Findings Of 1111 studies examined, 40 met our inclusion criteria, reporting on the carriage prevalence of Enterobacterales in 9408 children. The pooled carriage prevalence of ESCR-E was 32.2% (95% CI: 25.2%-40.2%). Between-study heterogeneity was high (I2 = 96%). The main sources of bias pertained to participant selection and the heterogeneity of the microbiological specimens. Carriage proportions were higher among sick children than healthy ones (35.7% vs 16.9%). The pooled proportion of nosocomial acquisition was 53.8% (95% CI: 32.1%-74.1%) among the 922 children without ESCR-E carriage at hospital admission. The pooled odds ratio of ESCR-E carriage after antibiotic treatment within the previous 3 months was 3.20 (95% CI: 2.10-4.88). The proportion of pooled carbapenem-resistant for Enterobacterales was 3.6% (95% CI: 0.7%-16.4%). Interpretation This study suggests that ESCR-E carriage among children in SSA is frequent. Microbiology capacity and infection control must be scaled-up to reduce the spread of those multidrug-resistant microorganisms. Funding There was no funding source for this study.
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Affiliation(s)
- Micaela Ruef
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephane Emonet
- Division of Infectious Diseases, Hospital of Valais, Sion, and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud Merglen
- Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Juan Emmanuel Dewez
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | - Basilice Minka Obama
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Regional Hospital Centre for Ebolowa, Cameroon
| | - Gaud Catho
- Infectious Diseases Division, Central Institute, Hospital of Valais, Switzerland
- Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diego O. Andrey
- Division of Infectious Diseases, Department of Medicine and Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Morgane Kowalski
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme and World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noémie Wagner
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Paediatric Emergency Medicine, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Bolujoko NB, Olorunnisola D, Poudel S, Omorogie MO, Ogunlaja OO, Olorunnisola CG, Adesina M, Deguenon E, Dougnon V, Alfred MO, Ogunlaja A, Olukanni OD, Msagati TAM, Unuabonah EI. Occurrence profiling, risk assessment, and correlations of antimicrobials in surface water and groundwater systems in Southwest Nigeria. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2024; 26:595-610. [PMID: 38323594 DOI: 10.1039/d3em00516j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
The presence of antimicrobials in water has grown into a major global health concern. This study thus focused on the presence, ecological implications, and potential health risks associated with nine antimicrobials: five antibiotics (ampicillin, chloramphenicol, ciprofloxacin, metronidazole, and tetracycline) and four parabens (methylparaben, ethylparaben, propylparaben, and butylparaben) in surface water and groundwater samples collected from three Southwestern States in Nigeria (Osun, Oyo, and Lagos States). These antimicrobials were widely detected across the three States with ciprofloxacin being the most dominant having maximum average concentrations of 189 μg L-1 and 319 μg L-1 in surface water and groundwater respectively. The range of average concentrations of antibiotics in surface water are 47.3-235 μg L-1 (Osun), 27.9-166 μg L-1 (Oyo) and 52.1-159 μg L-1 (Lagos). For groundwater, it is 35.3-180 μg L-1 (Osun), 26.5-181 μg L-1 (Oyo) and 32.3-319 μg L-1 (Lagos). The average concentrations of all parabens were 32.4-153 μg L-1, 53.4-80.1 μg L-1, and 83.2-132 μg L-1 for surface water and 46.7-55.7 μg L-1, 53-117 μg L-1, and 62.4-118 μg L-1 for groundwater in Osun, Oyo, and Lagos States respectively. Methylparaben was most frequently detected paraben with average concentrations of 153 μg L-1 and 117 μg L-1 in surface water and groundwater respectively. The measured environmental concentrations of these antimicrobials pose a significant ecological risk while those of ciprofloxacin and ampicillin pose a high health risk to all population groups studied. The average concentrations of antibiotics investigated in this study exceeded their threshold values for Predicted No-Effect Concentrations (PNEC) associated with resistance selection, except for tetracycline.
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Affiliation(s)
- Nathaniel B Bolujoko
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Chemical Sciences, Faculty of Natural Sciences, Redeemer's University, PMB 230, Ede, Osun State, Nigeria
| | - Damilare Olorunnisola
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Chemical Sciences, Faculty of Natural Sciences, Redeemer's University, PMB 230, Ede, Osun State, Nigeria
- University of Potsdam, Institute of Nutritional Science, 14558 Nuthetal, Arthur-Scheunert-Allee 114-116, Potsdam, Germany
- Institute of Chemistry, University of Potsdam, D-14476 Potsdam, Germany
| | - Sonika Poudel
- Department of Natural Resources and Ecology Management, Oklahoma State University, Stillwater, USA
| | - Martins O Omorogie
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Chemical Sciences, Faculty of Natural Sciences, Redeemer's University, PMB 230, Ede, Osun State, Nigeria
| | - Olumuyiwa O Ogunlaja
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Chemical Sciences, Faculty of Natural and Applied Sciences, Lead City University, Ibadan, Nigeria
| | - Chidinma G Olorunnisola
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Institute of Chemistry, University of Potsdam, D-14476 Potsdam, Germany
| | - Morenike Adesina
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Institute of Chemistry, University of Potsdam, D-14476 Potsdam, Germany
| | - Esther Deguenon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Benin
| | - Victorien Dougnon
- Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Polytechnic School of Abomey-Calavi, University of Abomey-Calavi, Benin
| | - Moses O Alfred
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Chemical Sciences, Faculty of Natural Sciences, Redeemer's University, PMB 230, Ede, Osun State, Nigeria
| | - Aemere Ogunlaja
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, PMB 230, Ede, Osun State, Nigeria
| | - Olumide D Olukanni
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Biochemistry, Faculty of Basic Medical Sciences, Redeemer's University, Ede, Nigeria
| | - Titus A M Msagati
- Institute for Nanotechnology and Water Sustainability, College of Science, Engineering and Technology, University of South Africa, South Africa, The Science Campus, Roodepoort, 1709, Johannesburg, South Africa
| | - Emmanuel I Unuabonah
- African Centre of Excellence for Water and Environmental Research (ACEWATER), Redeemer's University, PMB 230, Ede, 232101, Osun State, Nigeria.
- Department of Chemical Sciences, Faculty of Natural Sciences, Redeemer's University, PMB 230, Ede, Osun State, Nigeria
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Jing FH, Wang Q, He TJ, Xin N, Wang YW, Han Y, Wang X, Li Z. Three-Year Point Prevalence Survey of Antimicrobial Use in a Chinese University Hospital. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:6698387. [PMID: 38361762 PMCID: PMC10869184 DOI: 10.1155/2024/6698387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/28/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
To evaluate the prevalence and quality of antimicrobial prescriptions using a Global Point Prevalence Survey (PPS) tool and help identify targets for improvement of antimicrobial prescribing and inform the development of antimicrobial stewardship activities. Antimicrobial prescriptions for inpatients staying at a hospital overnight were surveyed on one weekday in October 2018, November 2019, and November 2020. Data including basic patient information, antimicrobial drugs, quality evaluation of antimicrobial drug prescription, and the risk factors of nosocomial infection were collected from doctor network workstation. Patient information was anonymized and entered in the PPS Web application by physicians. A total of 720 patients (median age, 62 years) were surveyed. Of them, 246 (34.2%) were prescribed antimicrobials on the survey days. Hospital-wide antimicrobial use had a significantly decreasing trend (P < 0.001). The most commonly prescribed antimicrobial drugs were third-generation cephalosporins (40.5%), followed by quinolones (21.8%) and second-generation cephalosporin (12.5%). In our study, cefoperazone/sulbactam, ceftazidime, and levofloxacin were the most commonly used antimicrobials. The most common indication for antimicrobial use was pneumonia or lower respiratory tract infection (159/321, 49.5%). Antimicrobial for surgical prophylaxis represented 16.2% of the total antibiotic doses. Of those, 67.3% were administered for more than 24 h. The rate of adherence to antibiotic guidelines was 61.4%. The indications for antimicrobials were not documented in 54.5% of the prescriptions. Stop/review date was documented for 36.8% of prescriptions. The PPS tool is useful in identifying targets to enhance the quality of antimicrobial prescriptions to improve the adherence rate in hospitals. This survey can be used as a control to assess the rational application quality of antimicrobial after regular application of antimicrobial intervention.
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Affiliation(s)
- Fa-Hong Jing
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Qiang Wang
- Department of Infection Management, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Tian-Jiao He
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Na Xin
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Yao-Wei Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Yang Han
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Xin Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
| | - Zhuo Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
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Kamara IF, Kanu J, Maruta A, Fofanah BD, Kamara KN, Sheriff B, Katawera V, D'Almeida SA, Musoke R, Nuwagira I, Lakoh S, Kamara RZ, Tengbe SM, Mansaray AR, Koroma Z, Thomas F, Abiri OT, Koroma AT, Russell JBW, Squire J, Vandi MA. Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology. BMJ Open 2023; 13:e078367. [PMID: 38159961 PMCID: PMC10759135 DOI: 10.1136/bmjopen-2023-078367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone. DESIGN We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology. SETTING The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services. PARTICIPANTS All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURES Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done. RESULTS Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%). CONCLUSION There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Joseph Kanu
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- Community Health, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | | | - Kadijatu Nabie Kamara
- National Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Victoria Katawera
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Selassi A D'Almeida
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Robert Musoke
- Emergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra Leone
| | | | - Abdul Razak Mansaray
- Laboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Onome T Abiri
- Pharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Pharmacology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Aminata Tigiedankay Koroma
- National Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - James Squire
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Alex Vandi
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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Yopa Demen DS, Nnanga Nga E, Ohandza CS, Gonsu Kamga H, Kouamen Njikeu ON, Nguefack-Tsague G. Antibiotic consumption history of patients in a referred laboratory in Yaounde. J Public Health Afr 2023; 14:2104. [PMID: 37441124 PMCID: PMC10334438 DOI: 10.4081/jphia.2023.2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/10/2022] [Indexed: 07/15/2023] Open
Abstract
Background Regulation of antibiotic prescription and consumption remains a major public health burden in low- and middle- income countries. Objective This study aimed to describe the antibiotic consumption of patients who had a positive antibiotic culture in a reference laboratory. Methods A retrospective descriptive study was conducted among 113 participants with positive antibiograms with a documented history of antibiotics intake at the Yaoundé University Teaching Hospital in Cameroon between January 2016 and June 2021. Data were stored and analyzed using the Census and Survey Processing System version 7.3 and Statistical Package for Social Science version 25.0. Descriptive statistics were used to estimate the indicators. Results Of the 113 patients enrolled, 105 had a history of drug use; 56 participants (53.3%) had taken at least 2 antibiotics prior to sampling. Cephalosporins were the most consumed antibiotics (41%), followed by nitroimidazols (28.6%) and penicillins (28.6%). According to the World Health Organization classification, 55 (52.4%) took major priority antibiotics. Conclusion We are on the alert and there is an urgent need to raise awareness among clinicians and patients alike by providing them with good clinical practice guidelines.
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Affiliation(s)
| | | | - Claude Stephan Ohandza
- Department of Infectious and Tropical Diseases, Fann University Teaching Hospital, Dakar, Senegal
| | - Hortense Gonsu Kamga
- Department of Microbiology-Parasitology-Hematology, University of Yaounde I, Cameroon
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10
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Siachalinga L, Godman B, Mwita JC, Sefah IA, Ogunleye OO, Massele A, Lee IH. Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications. Infect Drug Resist 2023; 16:2179-2190. [PMID: 37077250 PMCID: PMC10108870 DOI: 10.2147/idr.s398223] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with the data obtained from point prevalence surveys (PPS), hence the need to document antibiotic utilization patterns in sub-Saharan Africa. METHODS A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. RESULTS Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. CONCLUSION Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.
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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, 346, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, 02084, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, 100271, Nigeria
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hubert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Iyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
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11
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Umeokonkwo CD, Onah CK, Adeke AS, Igwe-Okomiso DO, Umeokonkwo AA, Madubueze UC, Dauda SO, Okeke KC, Versporten A, Oduyebo OO, Goossens H, Agu AP. Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey. J Infect Prev 2023; 24:71-76. [PMID: 36815059 PMCID: PMC9940237 DOI: 10.1177/17571774231152719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Aim Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. Subject and Method The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Result Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Conclusion Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.
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Affiliation(s)
- Chukwuma D Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Cosmas K Onah
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Azuka S Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Dorothy O Igwe-Okomiso
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Adanna A Umeokonkwo
- Department of Paediatric, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugochukwu C Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Saheed O Dauda
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Kingsley C Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Oyinlola O Oduyebo
- Department of Microbiology, Lagos University Teaching Hospital, Surulere, Nigeria
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Adaoha P Agu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
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Mittal N, Mittal R, Goel N, Parmar A, Bahl A, Kaur S, Gudibanda KR, Dudhraj V, Singh SK. WHO-Point Prevalence Survey of Antibiotic Use Among Inpatients at a Core National Antimicrobial Consumption Network Site in North India: Findings and Implications. Microb Drug Resist 2023; 29:1-9. [PMID: 36656989 DOI: 10.1089/mdr.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Data on Point Prevalence Surveys (PPSs) in India are limited yet. We report findings of a PPS conducted in a core "National Antimicrobial Consumption Network site" under National Centre for Disease Control - WHO project "Point prevalence survey of antimicrobial consumption at healthcare facilities." A cross-sectional survey was conducted as per the "WHO methodology for PPS on antibiotic use in hospitals" in a tertiary care hospital in India in December 2021. Data were collected using predesigned and pretested questionnaire in separate hospital, ward, and patient forms. Eight hundred two inpatients (excluding ICUs) were covered out of whom 299 (37.3%) were on antibiotics with 11.7% receiving 3 or more antibiotics. Surgical prophylaxis (SP) (42.5%) and community acquired infections (32.8%) were the most common indications for antibiotic use. Of the patients, 92.5% received SP for more than 24 hrs. Most commonly prescribed antibiotics were penicillins with beta-lactamase inhibitors (22.3%). Of the total antibiotic prescriptions, 81.5% were from WHO essential medicines list and 12% from "not recommended" WHO AWaRe classification. Of the antibiotic prescriptions, 84.6% were parenteral. Few prescriptions complied with standard treatment guidelines (1.9%), documented indication for antibiotic use (11.6%), and stop/review date (4.4%) in notes. Double anaerobic cover accounted for 6.8% of the total prescriptions. Some identified areas for improvement were: formulation of hospital antibiotic guidelines, promoting culture of sending cultures, improvement in surgical antibiotic prophylaxis, decreasing use of antibiotic combinations and double anaerobic cover, fostering IV to oral switch of antibiotics, and ensuring effective communication among health care workers by documenting adequate information in medical notes.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology and Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Rakesh Mittal
- Department of Pharmacology and Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Nidhi Goel
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Aparna Parmar
- Department of Microbiology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Arti Bahl
- National Center for Disease Control (NCDC), New Delhi, India
| | - Suneet Kaur
- National Center for Disease Control (NCDC), New Delhi, India
| | | | - Vibhor Dudhraj
- National Center for Disease Control (NCDC), New Delhi, India
| | - Sujeet K Singh
- National Center for Disease Control (NCDC), New Delhi, India
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Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future. Antibiotics (Basel) 2022; 11:antibiotics11121824. [PMID: 36551481 PMCID: PMC9774141 DOI: 10.3390/antibiotics11121824] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa.
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Obasanya JO, Ogunbode O, Landu-Adams V. An appraisal of the contextual drivers of successful antimicrobial stewardship implementation in Nigerian health care facilities. J Glob Antimicrob Resist 2022; 31:141-148. [PMID: 35973672 DOI: 10.1016/j.jgar.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) is a consequence of inappropriate actions, including irrational antimicrobial prescribing and use. Antimicrobial resistance remains an emergent and significant public health threat, particularly in low and middle-income countries (LMICs), including Nigeria. Optimizing antimicrobial (AM) use through functional hospital antimicrobial stewardship (AMS) programs is one of the strategies to control the spread of AMR. Literature is replete with evidence, but few studies examined the contextual factors limiting AMS functionality at the facility levels. This study explored the intrinsic contextual factors shaping AMS practice at the three-tiered levels of care. METHODS This was a qualitative case study with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. RESULTS Emergent themes include lack of AMS programs, inadequate guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. These findings demonstrate that the AMS program is lacking or poorly implemented at the three-tiered level of care. CONCLUSION We recommended that health facilities establish AMS programs in line with the World Health Organization's stepwise approach. These challenges, if addressed, will promote the successful performance of the AMS program, contributing to rational AM use at all levels of care. Since primary health centres constitute 85.4% of all health facilities, customizing the AMS core elements at this level will contribute to achieving the goals of universal health coverage.
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15
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Egwuenu A, Ejikeme A, Tomczyk S, von Laer A, Ayobami O, Odebajo O, Akhibi S, Agulanna C, Osagie O, Inweregbu US, Yahaya R, Okwor T, Dada-Adegbola H, Ajayi I, Olorukooba A, Eckmanns T, Ochu CL, Ihekweazu C. Baseline study for improving diagnostic stewardship at secondary health care facilities in Nigeria. Antimicrob Resist Infect Control 2022; 11:65. [PMID: 35505391 PMCID: PMC9066975 DOI: 10.1186/s13756-022-01080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Blood culture diagnostics are critical tools for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess reported sepsis case finding, blood culture diagnostics, antimicrobial susceptibility testing (AST) and antimicrobial use at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria. Methods A cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, Federal Capital Territory (FCT) and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Data were then prospectively extracted on all patients with reported suspected sepsis from electronic medical records from selected departments at two facilities in the Federal Capital Territory from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests. Results In the online survey, 32% (8/25) of facilities reported performing blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, the incidence of suspected sepsis cases reported was 7.1% (2924/41066). A majority of these patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]: 7.5, 95% CI: 4.6–12.3) and patients from the urban health care facility (aOR:16.9, 95% CI: 8.1–41.4) were significantly more likely to have a blood culture requested. Conclusion Low blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care, AMR surveillance and antibiotic use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.
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Aboderin AO, Adeyemo AT, Olayinka AA, Oginni AS, Adeyemo AT, Oni AA, Olabisi OF, Fayomi OD, Anuforo AC, Egwuenu A, Hamzat O, Fuller W. Antimicrobial use among hospitalized patients: A multi-center, point prevalence survey across public healthcare facilities, Osun State, Nigeria. Germs 2021; 11:523-535. [PMID: 35096669 PMCID: PMC8789356 DOI: 10.18683/germs.2021.1287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 10/21/2023]
Abstract
INTRODUCTION In order to inform sub-national action plan for control of antimicrobial resistance (AMR) and benchmark interventions to improve antibiotic use, it is essential to define situations on antibiotic use using standardized tools. We sought to assess quality of antimicrobial prescription across all government healthcare facilities with capacities for in-patient care in the first of the 36 states in Nigeria as part of ongoing state-wide situation analysis on AMR. METHODS A survey was conducted between 10-27 June 2019 using the WHO methodology for point prevalence survey on antibiotic use in hospitals. Data was collected from hospital administrators and records of hospitalized patients. Data analysis was done using Microsoft Excel 2010 (Redmond Washington). RESULTS Prevalence of antibiotic use amongst all 321 included patients was 76.6% (246/321). Of all indications recorded, the highest was surgical prophylaxis (96/260, 36.9%) for which there were multiple doses beyond 24 hours in almost all cases (91/96, 94.8%). The largest volume of prescribing took place in the surgical wards, and the most common prescriptions were metronidazole (142/564, 25.2%), cefuroxime (104/564, 18.4%), and ceftriaxone (77/564, 13.7%). Overall, 46.3% of the antibiotics used belong to Access group, 53.5% to watch and only 0.2% to Reserve. Treatment in almost all instances 544/563 (96.6%) was empiric. CONCLUSIONS The majority of patients received multiple antibiotics mostly without compliance to guidelines. There was low prescribing of Access antibiotics and excessive use of antibiotics in the Watch group. Antibiotics were used most commonly for surgical prophylaxis but inappropriately. Inappropriate use of antibiotics in this study underscores the crucial need for an action plan incorporating antimicrobial stewardship.
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Affiliation(s)
- Aaron O. Aboderin
- MBChB, MSc, FMCPath, FRCPath, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University & Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Adeyemi T. Adeyemo
- MBBS, FMCPath, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Ademola A. Olayinka
- MSc, Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, PMB 13, Ile-Ife, Nigeria
| | - Adeniyi S. Oginni
- MBChB, PhD, Osun State Health Insurance Scheme, Ogo-Oluwa, Osogbo, Nigeria
| | - Abolaji T. Adeyemo
- MBBS, FWACP, Department of Medical Microbiology, Ladoke Akintola University of Technology Teaching Hospital, PMB 5000, Osogbo, Nigeria
| | - Abayomi A. Oni
- MBChB, FWACS, Directorate of Medical Services, Hospital Management Board, Abere, Osogbo, Osun State, Nigeria
| | - Olatunde F. Olabisi
- MBChB, FMCPath, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Oluwaseun D. Fayomi
- MBBS, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Anthony C. Anuforo
- MBChB, Department of Medical Microbiology, Obafemi Awolowo University, Teaching Hospitals Complex, PMB 5538, Ile-Ife, Nigeria
| | - Abiodun Egwuenu
- MBBS, MPH, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Omotayo Hamzat
- BPharm MSc, World Health Organization, PMB 2861, Abuja, Nigeria
| | - Walter Fuller
- MD, World Health Organization Regional Office for Africa, P.O. Box 06, Brazzaville, Congo
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Iheanacho CO, Eze UIH. A systematic review of in-patients’ antimicrobial prescriptions and status of antimicrobial stewardship programmes in Nigerian hospitals. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00365-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Antimicrobial resistance is a major consequence of irrational antimicrobial prescriptions and consumptions, but this can be prevented by antimicrobial stewardship. The study systematically reviewed available evidence on antimicrobial prescriptions and antimicrobial stewardship (AMS) programmes in Nigerian hospitals. This will provide insight to the extent of required interventions, for improved healthcare.
Main body
Published research from January 1 2010 to March 31 2021 from PubMed, Scopus, Web of Science, African Journals Online and Google scholar databases was reviewed using Preferred Regulatory Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2009. Studies that reported antimicrobial use and antimicrobial stewardship programmes in Nigerian hospitals within the period in focus were assessed for eligibility. The National Heart, Lung and Blood Institute (NHLBI) quality assessment tool was used to assess quality of included studies. Among 15 studies included based on inclusion criteria, 12 reported on antimicrobial prescriptions and 3 reported on status of antimicrobial stewardship programmes in Nigerian hospitals. Most studies reported high prevalence of antimicrobials prescriptions with broad spectrum antimicrobials, majority of which were inappropriate. Empirical antimicrobial prescribing was common, and this was mostly done with less cognisance to existing guidelines. Only few hospitals were observed to have formal AMS teams in Nigeria.
Conclusion
Inappropriate prescribing of antimicrobials was common among prescribers in Nigeria. Although there was paucity of studies on status of AMS, the available few showed very low prevalence of AMS teams in hospitals. There is urgent need for implementation of AMS in Nigerian hospitals, to enhance rational antimicrobial use. Meanwhile more research on AMS in Nigerian hospitals is needed.
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Akande-Sholabi W, Ajamu AT. Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University. BMC MEDICAL EDUCATION 2021; 21:488. [PMID: 34507579 PMCID: PMC8434738 DOI: 10.1186/s12909-021-02912-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/28/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University. METHODS Respondents' knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents' knowledge. RESULTS Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7-22.96)], had greater knowledge of antimicrobial resistance. CONCLUSIONS The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.
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Affiliation(s)
- Wuraola Akande-Sholabi
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Amen T. Ajamu
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
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Yusef D, Hayajneh WA, Bani Issa A, Haddad R, Al-Azzam S, Lattyak EA, Lattyak WJ, Gould I, Conway BR, Bond S, Conlon-Bingham G, Aldeyab MA. Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan. J Antimicrob Chemother 2021; 76:516-523. [PMID: 33219679 DOI: 10.1093/jac/dkaa464] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients. METHODS The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods. RESULTS Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237). CONCLUSIONS The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.
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Affiliation(s)
- Dawood Yusef
- Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Wail A Hayajneh
- Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ali Bani Issa
- Infection Control Division, King Abdullah University Hospital, Irbid, Jordan
| | - Rami Haddad
- Information Technology Department, King Abdullah University Hospital, Irbid, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Ian Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.,Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Stuart Bond
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | | | - Mamoon A Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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Ogunleye OO, Oyawole MR, Odunuga PT, Kalejaye F, Yinka-Ogunleye AF, Olalekan A, Ogundele SO, Ebruke BE, Kalada Richard A, Anand Paramadhas BD, Kurdi A, Sneddon J, Seaton A, Godman B. A multicentre point prevalence study of antibiotics utilization in hospitalized patients in an urban secondary and a tertiary healthcare facilities in Nigeria: findings and implications. Expert Rev Anti Infect Ther 2021; 20:297-306. [PMID: 34128756 DOI: 10.1080/14787210.2021.1941870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The understanding of antimicrobial utilization patterns is pertinent to successful implementation of the National Action Plans on Antimicrobial Resistance (AMR). There is, however, limited information on antibiotics utilization in Nigeria. This study was undertaken to build on existing information and provide direction for appropriate interventions including Antibiotics Stewardship Programs (ASP). METHOD A Point Prevalence Study (PPS) was conducted in two public urban health facilities in Lagos, Nigeria using a design adapted from the European Center for Disease Prevention and Control (ECDC) and Global-PPS surveys. RESULTS The prevalence of antibiotics use was 80.6% administered mostly parenterally (83.1% of total prescriptions) with concerns with extended surgical antibiotics prophylaxis. The mostly used antibiotics in the secondary hospital were parenteral metronidazole (32.4%), ceftriaxone (27.5%), and amoxicillin + clavulanate (8.2%) while the mostly used in the tertiary hospital were ceftriaxone (25.3%), parenteral metronidazole (19.1%), and amoxicillin + clavulanate (9.3%). There was an appreciable lack of specific functional capacities, policies, and processes to promote appropriate antimicrobial use in both hospitals. CONCLUSIONS There is high rate of antibiotics utilization in these facilities with lack of institutional frameworks and processes for ensuring appropriate antibiotic use. The study provides the information needed to improve future antimicrobial use in hospitals and reduce AMR.
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Affiliation(s)
- Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Modupe R Oyawole
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Patricia T Odunuga
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Folasade Kalejaye
- Department of Pharmacy, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Adesola F Yinka-Ogunleye
- Nigerian Centre for Disease Control, Federal Capital Territory, Abuja, Nigeria.,Institute of Global Health, University College, London, UK
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos, Nigeria.,Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos, Nigeria
| | - Sunday O Ogundele
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Diseases In Nigeria (IFAIN), Abuja, Nigeria
| | | | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Andrew Seaton
- Healthcare Improvement Scotland, Delta House, Glasgow, UK.,Queen Elizabeth University Hospital, Glasgow, UK.,University of Glasgow, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK.,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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21
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Jamaluddin NAH, Periyasamy P, Lau CL, Ponnampalavanar S, Lai PSM, Ramli R, Tan TL, Kori N, Yin MK, Azman NJ, James R, Thursky K, Naina-Mohamed I. Point Prevalence Survey of Antimicrobial Use in a Malaysian Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:531. [PMID: 34064457 PMCID: PMC8148015 DOI: 10.3390/antibiotics10050531] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 12/02/2022] Open
Abstract
Antimicrobial resistance remains a significant public health issue, and to a greater extent, caused by the misuse of antimicrobials. Monitoring and benchmarking antimicrobial use is critical for the antimicrobial stewardship team to enhance prudent use of antimicrobial and curb antimicrobial resistance in healthcare settings. Employing a comprehensive and established tool, this study investigated the trends and compliance of antimicrobial prescribing in a tertiary care teaching hospital in Malaysia to identify potential target areas for quality improvement. A point prevalence survey method following the National Antimicrobial Prescribing Survey (NAPS) was used to collect detailed data on antimicrobial prescribing and assessed a set of quality indicators associated with antimicrobial use. The paper-based survey was conducted across 37 adult wards, which included all adult in-patients on the day of the survey to form the study population. Of 478 patients surveyed, 234 (49%) patients received at least one antimicrobial agent, with 357 antimicrobial prescriptions. The highest prevalence of antimicrobial use was within the ICU (80%). Agents used were mainly amoxicillin/β-lactamase inhibitor (14.8%), piperacillin/β-lactamase inhibitor (10.6%) and third-generation cephalosporin (ceftriaxone, 9.5%). Intravenous administration was ordered in 62.7% of prescriptions. Many antimicrobials were prescribed empirically (65.5%) and commonly prescribed for pneumonia (19.6%). The indications for antimicrobials were documented in the patients' notes for 80% of the prescriptions; however, the rate of review/stop date recorded must be improved (33.3%). One-half of surgical antimicrobial prophylaxis was administered for more than 24 h. From 280 assessable prescriptions, 141 (50.4%) were compliant with guidelines. Treating specialties, administration route, class of antimicrobial, and the number of prescriptions per patient were contributing factors associated with compliance. On multivariate analysis, administering non-oral routes of antimicrobial administration, and single antimicrobial prescription prescribed per patient was independently associated with non-compliance. NAPS can produce robust baseline information and identifying targets for improvement in antimicrobial prescribing in reference to current AMS initiatives within the tertiary care teaching hospital. The findings underscore the necessity to expand the AMS efforts towards reinforcing compliance, documentation, improving surgical prophylaxis prescribing practices, and updating local antibiotic guidelines.
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Affiliation(s)
- Nurul Adilla Hayat Jamaluddin
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
- Department of Hospital and Clinical Pharmacy, Faculty of Pharmacy, University of Cyberjaya, Cyber 11, Cyberjaya, Selangor 63000, Malaysia
| | - Petrick Periyasamy
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (P.P.); (N.K.)
| | - Chee Lan Lau
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia; (C.L.L.); (M.K.Y.); (N.J.A.)
| | | | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | - Ramliza Ramli
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Toh Leong Tan
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Najma Kori
- Medical Department, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia; (P.P.); (N.K.)
| | - Mei Kuen Yin
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia; (C.L.L.); (M.K.Y.); (N.J.A.)
| | - Nur Jannah Azman
- Pharmacy Department, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur 56000, Malaysia; (C.L.L.); (M.K.Y.); (N.J.A.)
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne 3000, Australia; (R.J.); (K.T.)
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Research Institute for Infection and Immunity, Melbourne 3000, Australia; (R.J.); (K.T.)
| | - Isa Naina-Mohamed
- Pharmacoepidemiology and Drug Safety Unit, Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
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22
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Ogoina D, Iliyasu G, Kwaghe V, Otu A, Akase IE, Adekanmbi O, Mahmood D, Iroezindu M, Aliyu S, Oyeyemi AS, Rotifa S, Adeiza MA, Unigwe US, Mmerem JI, Dayyab FM, Habib ZG, Otokpa D, Effa E, Habib AG. Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria. Antimicrob Resist Infect Control 2021; 10:73. [PMID: 33931108 PMCID: PMC8086089 DOI: 10.1186/s13756-021-00940-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR. METHODS In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert's scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model. RESULTS A total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr. CONCLUSIONS Our study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria's NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.
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Affiliation(s)
- Dimie Ogoina
- Dimie Ogoina Infectious Disease Unit, Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital, Yenagoa, Bayelsa State, Nigeria.
| | - Garba Iliyasu
- Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | - Vivian Kwaghe
- Infectious Disease Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Gwagwadala, Nigeria
| | - Akan Otu
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Iorhen Ephram Akase
- Department of Internal Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, University College Hospital/University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Dalhat Mahmood
- Nigeria Centre for Disease Control (NCDC), African Field Epidemiology Network (AFENET), Abuja, Nigeria
| | - Micheal Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria
| | - Shamsudin Aliyu
- Department of Medical Microbiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Abisoye Sunday Oyeyemi
- Department of Community Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Stella Rotifa
- Department of Community Medicine, Federal Medical Centre Yenagoa, Yenagoa, Bayelsa State, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Department of Internal Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Uche Sonny Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria
| | - Juliet Ijeoma Mmerem
- Department of Medicine, University of Nigeria Teaching Hospital Ituku/Ozalla Enugu, Ituku, Enugu State, Nigeria
| | - Farouq Muhammad Dayyab
- Infectious Disease Hospital, Kano, Nigeria
- Department of Medicine, Federal Medical Center, Nguru, Yobe State, Nigeria
| | - Zaiyad Garba Habib
- Infectious Disease Unit, Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Gwagwadala, Nigeria
| | - Daniel Otokpa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Emmanuel Effa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious Disease Unit, Department of Internal Medicine, Aminu Kano University Teaching Hospital, Kano, Nigeria
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23
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Chukwu EE, Oshun PO, Osuolale KA, Chuka-Ebene VO, Salako A, Idigbe IE, Oladele D, Audu RA, Ogunsola FT. Antimicrobial stewardship programmes in healthcare facilities in Lagos State, Nigeria: a needs assessment. J Glob Antimicrob Resist 2021; 25:162-170. [PMID: 33812050 DOI: 10.1016/j.jgar.2021.02.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/29/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Optimising antibiotic use in healthcare settings through antimicrobial stewardship programmes (ASPs) is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antimicrobial resistance. This needs assessment was designed to provide the current status of ASPs in healthcare facilities in Lagos State and identify gaps for future interventions. METHODS A descriptive cross-sectional survey was conducted using a self-administered questionnaire to ascertain the extent and nature of ongoing ASPs among selected healthcare facilities and identify gaps for future interventional studies. RESULTS Of 32 questionnaires distributed, 25 (78%) were completed and returned from three tertiary, six secondary, eleven primary and five private healthcare facilities. The mean years of practice of respondents was 13.96 ± 7.8 years (2-31 years). Six facilities (24%) had a team responsible for ASP operating at varying degrees of capacity, while five (20%) had a formal ASP. All six facilities with an antimicrobial stewardship (AMS) team had a medical doctor as the team lead, and 5 (20%) also had a pharmacist involved in implementation efforts. Routine pre-authorisation for specific antibiotic was performed in six facilities (24%), four of which monitor pre-authorisation interventions. Only two facilities (8%) performed prospective audit and feedback for specific antibiotic agents. Private healthcare facilities were more likely to have information technology (IT) capability to support the needs of AMS activities. CONCLUSION This study revealed minimal ASP activities in healthcare facilities in Lagos State and highlighted possibilities of leveraging on available IT resources for a co-ordinated AMS strategy.
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Affiliation(s)
- Emelda E Chukwu
- Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria.
| | - Philip O Oshun
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Kazeem A Osuolale
- Monitoring and Evaluation Unit, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | | | - Abideen Salako
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Ifeoma E Idigbe
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - David Oladele
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Rosemary A Audu
- Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Folasade T Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos State, Nigeria
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24
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Dodoo CC, Orman E, Alalbila T, Mensah A, Jato J, Mfoafo KA, Folitse I, Hutton-Nyameaye A, Okon Ben I, Mensah-Kane P, Sarkodie E, Kpokiri E, Ladva M, Awadzi B, Jani Y. Antimicrobial Prescription Pattern in Ho Teaching Hospital, Ghana: Seasonal Determination Using a Point Prevalence Survey. Antibiotics (Basel) 2021; 10:199. [PMID: 33670731 PMCID: PMC7923162 DOI: 10.3390/antibiotics10020199] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022] Open
Abstract
A standardised Global Point Prevalence Survey (PPS) tool was used to determine the antimicrobial prescription pattern in the Ho Teaching Hospital on two separate occasions in a total of 14 wards in the hospital, including dedicated wards for paediatrics and neonates. Manually collected and anonymised data were entered, validated, analysed and reported using a web-based global PPS application. With 147 and 153 patients considered in the July 2019 and January 2020 surveys, respectively, 98 patients (66.7%) and 84 patients (54.9%) had received one or more antimicrobials. The prevalence of antimicrobial use in the adult wards was 64.3% (72/112) and 53.4% (63/118) in the first and second surveys, respectively. The prevalence in the paediatric wards was 60.0% (12/20) and 62.5% (10/16), respectively, in the two surveys, while that in the neonatal wards was 93.3% (14/15) and 57.9% (11/19), respectively. β-lactams were the most used antibiotics in both periods. Malaria was the most common diagnosis requiring the use of antimicrobials in July 2019, accounting for 19.4% of the diagnoses, whereas in January 2020, it was skin and soft-tissue conditions (28.1%). This reflects a seasonal association between malaria and rainfall patterns. Out of the antimicrobials prescribed during each of the survey periods, 95% were used for empirical treatment, and this could be attributed to a number of reasons, including logistical challenges, among others, that require further exploration in the context of local, national and international policy recommendations.
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Affiliation(s)
- Cornelius C. Dodoo
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Emmanuel Orman
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Thelma Alalbila
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Adelaide Mensah
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Jonathan Jato
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Kwadwo A. Mfoafo
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Isaac Folitse
- Ho Teaching Hospital, P.O. Box MA 374, Ho, Ghana; (I.F.); (B.A.)
| | - Araba Hutton-Nyameaye
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Inemesit Okon Ben
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Paapa Mensah-Kane
- School of Pharmacy, University of Health and Allied Sciences, PMB 31, Ho, Ghana; (E.O.); (T.A.); (A.M.); (J.J.); (K.A.M.); (A.H.-N.); (I.O.B.); (P.M.-K.)
| | - Emmanuel Sarkodie
- Department of Pharmacy, Kwame Nkrumah University of Science and Technology Hospital, University Post Office, KNUST, Kumasi, Ghana;
| | - Eneyi Kpokiri
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1N 1AX, UK;
- Department of Practice and Policy, University College London School of Pharmacy, London WC1N 1AX, UK
| | - Misha Ladva
- Joint Research Office, University College London, London WC1E 6BT, UK;
- Centre for Medicines Optimisation Research and Education, University College London Hospitals, NHS Foundation Trust, London NW1 2BU, UK
| | - Benedict Awadzi
- Ho Teaching Hospital, P.O. Box MA 374, Ho, Ghana; (I.F.); (B.A.)
| | - Yogini Jani
- Department of Practice and Policy, University College London School of Pharmacy, London WC1N 1AX, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals, NHS Foundation Trust, London NW1 2BU, UK
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Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med 2021; 14:515-530. [PMID: 33633461 PMCID: PMC7901404 DOI: 10.2147/ijgm.s253216] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a concern with the growing use of antimicrobials across countries increasing antimicrobial resistance (AMR) rates. A key area within hospitals is their use for the prevention of surgical site infections (SSI) with concerns with timing of the first dose, which can appreciably impact on effectiveness, as well as duration with extended prophylaxis common among low- and middle-income countries (LMICs). This is a concern as extended duration increases utilization rates and AMR as well as adverse events. Consequently, there is a need to document issues of timing and duration of surgical antibiotic prophylaxis (SAP) among LMICs together with potential ways forward to address current concerns. METHODS Narrative review of timings and duration of SAP among LMICs combined with publications documenting successful approaches to improve SAP to provide future direction to all key stakeholder groups. RESULTS There were documented concerns with the timing of the first dose of antibiotics, with appropriate timing as low as 6.7% in Egypt, although as high as 81.9% in Turkey. There was also an extensive duration of SAP, ranging from long duration times in all patients in a study in Nigeria with a mean of 8.7 days and 97% of patients in Egypt to 42.9% of patients in Pakistan and 35% in Turkey. Successful interventions to improve SAP typically involved multiple approaches including education of all key stakeholder groups, monitoring of usage against agreed guidelines,as well as quality targets. Multiple approaches typically improved timing and duration as well as reduced costs. For instance, in one study appropriateness increased from 30.1% to 91.4%, prolonged duration reduced to 5.7% of patients, and mean costs of antibiotics decreased 11-fold. CONCLUSION There are considerable concerns with the timing and duration of SAP among LMICs. Multiple interventions among LMICs can address this providing future directions.
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Affiliation(s)
- Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Centre for Genomics of Non-Diseases and Personalized Healthcare (CGNPH), University of Lagos, Lagos, Nigeria
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Ajibola AS, Amoniyan OA, Ekoja FO, Ajibola FO. QuEChERS Approach for the Analysis of Three Fluoroquinolone Antibiotics in Wastewater: Concentration Profiles and Ecological Risk in Two Nigerian Hospital Wastewater Treatment Plants. ARCHIVES OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2021; 80:389-401. [PMID: 33247335 DOI: 10.1007/s00244-020-00789-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/12/2020] [Indexed: 05/25/2023]
Abstract
Hospital wastewater is regarded as a primary and very important source of antibiotics in the aquatic environment. Studies on the analysis, occurrence, and ecological risk assessment of fluoroquinolone antibiotics in wastewater are still limited in Africa. A quick, easy, cheap, effective, rugged, and safe extraction method was optimized and applied for determination of three fluoroquinolone antibiotics (ciprofloxacin, norfloxacin, and ofloxacin) in wastewater from two Nigerian hospital wastewater treatment plants (WWTPs) and effluent receiving water. Separation, detection, and quantification of target fluoroquinolone antibiotics were performed by high-performance liquid chromatography. Ecological risk of the three fluoroquinolone antibiotics was evaluated for three trophic levels: fish, daphnid, and algae. The method LODs were 4.1 µg L-1, 7.0 µg L-1, and 18.5 µg L-1 for ciprofloxacin, norfloxacin, and ofloxacin, respectively. Satisfactory recoveries and precisions were achieved, in addition to the correlation coefficients of greater than 0.993. Target fluoroquinolones were quantified in influents up to 228 µg L-1 (UCH influent) for ciprofloxacin, 561 µg L-1 (Ijaiye influent) for norfloxacin, and 198 µg L-1 (UCH influent) for ofloxacin. Norfloxacin had the highest concentration (386 µg L-1) in effluent receiving water. All three fluoroquinolones posed low risk to fish, whereas ciprofloxacin and norfloxacin presented moderate risk to daphnid and algae. To the best of our knowledge, this work presents the first data on the occurrence and risk assessment of the target fluoroquinolones in wastewater from Nigerian hospital WWTPs. The findings revealed the importance of developing local and nationwide surveys of fluoroquinolone antibiotics in the Nigerian aquatic environment.
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Affiliation(s)
- Akinranti S Ajibola
- Analytical/Environmental Unit, Department of Chemistry, University of Ibadan, Ibadan, Nigeria.
| | - Oluwasegun A Amoniyan
- Analytical/Environmental Unit, Department of Chemistry, University of Ibadan, Ibadan, Nigeria
| | - Faith O Ekoja
- Analytical/Environmental Unit, Department of Chemistry, University of Ibadan, Ibadan, Nigeria
| | - Florence O Ajibola
- Department of Crop Protection and Environmental Biology (Ecotoxicology), University of Ibadan, Ibadan, Nigeria
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Nnadozie U, Umeokonkwo C, Maduba C, Onah I, Igwe-Okomiso D, Ogbonnaya I, Onah C, Okoye P, Versporten A, Goossens H. Patterns of antimicrobial use in a specialized surgical hospital in Southeast Nigeria: Need for a standardized protocol of antimicrobial use in the tropics. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_225_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sisay M, Gashaw T, Amare F, Tesfa T, Baye Y. Hospital-Level Antibacterial Prescribing and Its Completeness in Ethiopia: Did It Adhere to Good Prescribing Practice? Int J Gen Med 2020; 13:1025-1034. [PMID: 33192086 PMCID: PMC7654516 DOI: 10.2147/ijgm.s280696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background Antibacterial agents are an integral part of chemotherapy and play a critical role in the prophylaxis and treatment of bacterial infections. However, prescribing errors such as incomplete prescriptions that do not adhere to good prescribing practice have become a contemporary concern in hospitals in resource-limited settings. Therefore, this study aimed to assess antibacterial prescribing and its completeness among prescriptions dispensed at four governmental hospitals in Eastern Ethiopia. Methods A cross-sectional study was employed to assess a total of 1308 prescription encounters containing at least one antibacterial agent obtained with simple random sampling from annual antibacterial-containing prescription data of four hospitals. The data were collected retrospectively using a structured checklist. Results A total of 2,855 drugs were prescribed from 1308 prescribing encounters with 1496 (52.39%) being antibacterial agents. The name, age, sex, and diagnosis of the patients were written in 1158 (88.3%), 815 (62.31%), 796 (60.58%), and 183 (13.99%) prescriptions, respectively. Besides, the route of administration, strength, duration, quantity, dose, and dosage form of the drug were recorded in 2322 (81.33%), 2118 (74.19%), 1516 (53.10%), 1525 (53.42%), 746 (26.13%) and 563 (19.72%) prescriptions, respectively. Nearly 50% of the prescribing encounters were documented without a prescriber name. Dispenser name and signature were also obtained in less than 10% of the prescriptions. Combining the data of all hospitals, amoxicillin, ceftriaxone, and ciprofloxacin were identified as the top three prescribed antibacterial drugs, whereas diclofenac, paracetamol, and tramadol were the most frequently co-indicated drugs. Regarding the pharmacologic class of antibiotics, penicillins were the most commonly prescribed antibiotics (n = 596, 39.77%) followed by cephalosporins (n = 318, 21.26%) and fluoroquinolones (n=285, 19.05%). Conclusion Incomplete information about patient-related factors and major diagnosis, medication regimens, prescribers and dispensers was identified as a potential prescribing error and did not adhere to good prescribing practice. This can be considered as one part of the inappropriate use of antibacterial agents, a driving force for the emergence of antimicrobial resistance. This problem requires immediate and sustained action from the management of the hospitals to ensure the accountability of health professionals involved in the medication use process and to establish antimicrobial stewardship programs in such resource-limited settings.
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Affiliation(s)
- Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Microbiology Unit, Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Babatola AO, Fadare JO, Olatunya OS, Obiako R, Enwere O, Kalungia A, Ojo TO, Sunmonu TA, Desalu O, Godman B. Addressing antimicrobial resistance in Nigerian hospitals: exploring physicians prescribing behavior, knowledge, and perception of antimicrobial resistance and stewardship programs. Expert Rev Anti Infect Ther 2020; 19:537-546. [PMID: 32990480 DOI: 10.1080/14787210.2021.1829474] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We assessed the knowledge of, attitude toward antimicrobial resistance (AMR) and practice of antimicrobial stewardship (AMS) among physicians in Nigeria to provide future guidance to the Nigerian National Action Plan for AMR. METHODS A descriptive cross-sectional questionnaire-based study explored the physicians' self-reported practice of antibiotic prescribing, knowledge, attitude, and practice of AMR and components of ASPs. RESULTS The majority (217; 67.2%) of respondents prescribed antibiotics daily in their clinical practice AMR was recognized as a global and local problem by 308 (95.4%) and 262 (81.1%) respondents, respectively. Only 91 (28.2%) of respondents have ever heard of antibiotic stewardship. The median AMR knowledge score was 40 (19-45)out of 45while that for ASP was 46.0(32-57) out of 60. There was significant statistical difference between the ASP median scores among the medical specialties category (P value <0.0001) More respondents had good knowledge of AMR than ASPs (82.7% versus 36.5%; p < 0.0001). CONCLUSION Respondents in this study were more knowledgeable about AMR than AMS and its core components.
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Affiliation(s)
- Adefunke O Babatola
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladele S Olatunya
- Department of Paediatrics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Reginald Obiako
- Department of Clinical Pharmacology, Ahmadu Bello University, Zaria, Nigeria.,Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Okezie Enwere
- Department of Medicine, Imo State University, Orlu, Nigeria
| | - Aubrey Kalungia
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Temitope O Ojo
- Department of Community Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Olufemi Desalu
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Brian Godman
- Department of Pharmacy, Faculty of Health Sciences, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
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30
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Nnadozie UU, Umeokonkwo CD, Maduba CC, Igwe-Okomiso D, Onah CK, Madubueze UC, Anikwe CC, Versporten A, Pauwels I, Goossens H, Ogbuanya AUO, Oduyebo OO, Onwe EO. Antibiotic use among surgical inpatients at a tertiary health facility: a case for a standardized protocol for presumptive antimicrobial therapy in the developing world. Infect Prev Pract 2020; 2:100078. [PMID: 34368721 PMCID: PMC8336176 DOI: 10.1016/j.infpip.2020.100078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022] Open
Abstract
Background Indiscriminate antimicrobial use is one of the greatest contributors to antimicrobial resistance. A low level of asepsis in hospitals and inadequate laboratory support have been adduced as reasons for indiscriminate use of antimicrobials among surgical patients. At present, there are no guidelines for presumptive antibiotic use in Nigeria and sub-Saharan Africa. Aim Surgical inpatients at the study hospital were surveyed to determine the level of antimicrobial use and degree of compliance with prescription quality indicators. Methods A cross-sectional survey was conducted among all surgical inpatients in May 2019 using a standardized tool developed by the University of Antwerp to assess the point prevalence of antimicrobials. Inpatients who were admitted from 08:00 h on the day of the survey were included. Data on patients' demographics, indication for antimicrobial use, reason for antimicrobial use, stop/review date, adherence to guidelines and laboratory use were collected. The prevalence of antimicrobial use in the surgical department was estimated. Results Eighty-two inpatients were included in the survey. Of these, 97.6% were receiving at least one antimicrobial agent. Only 5.4% of the prescriptions were targeted, and 37.6% of prescriptions were for empirical treatment of infections. Approximately half (50.7%) of the patients were receiving presumptive antibiotics, and 6% were receiving prophylactic antibiotics. In total, 58.7% of prescriptions were administered parenterally, and 98.2% of patients had documentation of a stop/review date. Metronidazole (P=32.3%, T=29.2%), ceftriaxone (P=28.4%, T=19.8%) and ciprofloxacin (P=14.2%, T=14.6%) were the most common antimicrobials used. Conclusions There is a high rate of antimicrobial use among surgical inpatients, and the rate of indiscriminate antimicrobial prescribing among these patients needs to be reduced. This can be achieved by developing antimicrobial guidelines for presumptive antimicrobial therapy.
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Affiliation(s)
- U U Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria.,Department of Surgery, College of Health Sciences, Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - C D Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - C C Maduba
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria
| | - D Igwe-Okomiso
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - C K Onah
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - U C Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - C C Anikwe
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - A Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - I Pauwels
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - A U-O Ogbuanya
- Department of Surgery, College of Health Sciences, Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - O O Oduyebo
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - E O Onwe
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Integrated one-day surveillance of antimicrobial use, antimicrobial consumption, antimicrobial resistance, healthcare-associated infection, and antimicrobial resistance burden among hospitalized patients in Thailand. J Infect 2020; 81:98-106. [PMID: 32360884 DOI: 10.1016/j.jinf.2020.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Surveillance of antimicrobial use (AMU), antimicrobial consumption (AMC), antimicrobial resistance (AMR), healthcare-associated infection (HAI), and AMR burden are usually measured by time-consuming and expensive multiple separate longitudinal surveys. This study aimed to investigate feasibility and benefit of integrated one-day surveillance to estimate and monitor these parameters. METHODS Integrated one-day surveillance of AMU, AMC, AMR, HAI, and AMR burden among hospitalized patients in 183 hospitals in Thailand was conducted. Parameter data was collected for each patient who received antibiotic on a survey day. RESULTS AMU prevalence was 51.5% among 23,686 hospitalized patients. The most commonly used antibiotic for infection prophylaxis and treatment was cefazolin and ceftriaxone, respectively. The most common infection was pneumonia. Community-associated infection (CAI) was observed in 64.9%, and 34.1% had HAI. Prevalence of AMR was highest in A. baumannii infection. AMR in bacteria was more prevalent among HAI than among CAI. Consumption of all antibiotics was 18,103 defined daily doses. HAI prevalence was 14.0%. Health and economic burden were much higher in patients with antibiotic-resistant infection. CONCLUSIONS Integrated one-day surveillance of these important parameters among hospitalized patients is feasible and can be used for estimation and monitoring from the facility-level to the national-level in resource-limited settings.
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Abubakar U. Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey. BMC Infect Dis 2020; 20:86. [PMID: 32000722 PMCID: PMC6990515 DOI: 10.1186/s12879-020-4815-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The evaluation of antibiotic use among hospitalized patients is a primary step required to design antibiotic stewardship intervention. There is paucity of data describing antibiotic use in hospitals across Northern Nigeria. This study evaluates the prevalence and indications for antibiotic use among inpatients in three acute care hospitals. METHODS A point-prevalence survey was conducted among patients in the wards before or at 8.00 a.m. on the day of the survey, using the point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals protocol. The survey was conducted between April and May 2019. The medical records of the patients were reviewed by a clinical pharmacist with the support of physicians and nurses. RESULTS Overall, 80.1% (257/321) of the patients used at least one antibiotic on the day of the survey. The prevalence of antibiotic use ranged from 72.9% in obstetrics and gynecology to 94.6% in pediatric medical specialty. Community acquired infections (38.7%) and surgical antibiotic prophylaxis (22.5%) were the most common indications. Surgical antibiotic prophylaxis was used or scheduled to be used for more than a day in all the cases. Metronidazole (30.5%), ciprofloxacin (17.1%), ceftriaxone (16.8%), amoxicillin-clavulanate (12.5%) and gentamicin (11.8%) were the most commonly prescribed antibiotics. Overall, broad spectrum antibiotics represented one-third of all the prescriptions. The change of initial antibiotic prescription was reported in one-third of the patients and the reasons include a switch to oral antibiotic (28.5%), escalation (4.5%) and de-escalation (3.6%). Of the 257 patients with an antibiotic prescription, 6.2% had redundant antibiotic combinations. CONCLUSION The prevalence of antibiotic use was high with one in three prescriptions having a broad spectrum antibiotic. Prolonged use of surgical antibiotic prophylaxis and redundant antibiotic combination were observed. Antimicrobial stewardship interventions are recommended in order to reduce the use of antibiotics and promote appropriate antibiotics prescribing.
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Affiliation(s)
- Usman Abubakar
- Pharmacy Department, Ibrahim Badamasi Babangida (IBB) Specialist Hospital, Minna, Niger, Nigeria.
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