Knowledge, attitude and practice of Gambian health practitioners towards antibiotic prescribing and microbiological testing: a cross-sectional survey

Interprofessional education in antimicrobial stewardship, a collaborative effort

Introduction

Antimicrobial stewardship (AMS) education and interprofessional collaboration are integral to the success of a stewardship programme. An interactive interprofessional AMS workshop, designed to encourage workplace interprofessional collaboration was piloted in a tertiary hospital.

Objectives

To obtain feedback to determine the suitability and sustainability of the AMS workshop.

Methods

Feedback was elicited through a predesigned questionnaire containing both open-ended and closed questions on the content and structure of the workshop.

Results

The survey had a 70% (n = 16) overall response rate. All participants agreed that the goals of the workshop were met and that the knowledge and skills gained from the workshop would help them in their AMS roles. All participants indicated that the workshop content, and the level at which it was pitched, met their expectations and that it had improved their knowledge and skills. All agreed that they found it advantageous and enjoyed learning as an interprofessional group. Open feedback showed that the workshop was found to be useful and would potentially result in improved patient care, dissemination of knowledge, improved teamwork and organizational culture.

Conclusions

The positive feedback and changes made following the workshop demonstrated that a targeted AMS educational workshop adds value to an antimicrobial stewardship programme.

Knowledge, attitude, and practice on antibiotics use among healthcare workers: A cross-sectional study in Niger state, Nigeria

Introduction

Antibiotic resistance is a public health concern in Nigeria and the world, and healthcare workers contributed to the upsurge of antibiotic resistance in hospital settings. This study focused on the knowledge, attitude, and practice (KAP) of antibiotic use and the frequency of prescriptions of antibiotics from the list of WHO Model Essentials Antibiotics (AWaRe) (in the last 6 months) among healthcare workers and established the determining factors in six hospitals in Niger state, Nigeria.

Methodology

A KAP survey was conducted in Niger State, Nigeria, from March to June 2022. A structured self-administered, pretested questionnaire was distributed to six hospitals in the state following a stratified random sampling considering the staff capacity, the population of the city, and patients' patronage.

Results

A total of 350 questionnaires distributed, and 313 (89.4%) completed and returned from the six hospitals. The median scores were knowledge (75%), attitude (69%), practice (62%), and self-reported prescription (70%), and respondents with good scores were knowledge [195 (62.3%)], attitude [185 (59.1%)], practice [201 (64.2%)], and prescription [117 (37.4%)]. In multivariate analysis, older respondents are more likely to have a good prescription (p = 0.006), and prior antimicrobial training improved their knowledge (p < 0.001), attitude (p = 0.007), and prescription pattern (p = 0.009). All the study participants had prescribed one or more of the most prescribed antibiotics; Amoxicillin clavulanate (Access group, 96.5%), Amoxicillin (Access group, 95.9%), and Metronidazole (Access group, 95.7%).

Conclusions

The study suggests that antibiotic education for healthcare workers and antimicrobial stewardship programs are significant interventions to mitigate antibiotic overuse in the state.

Maurice A, Dogan TL, Ceesay B, Umukoro S, Okomo U, Nwakanma D, Roca A, Secka O, Forrest K, Garner OB. Using an Antibiogram Profile to Improve Infection Control and Rational Antimicrobial Therapy in an Urban Hospital in The Gambia, Strategies and Lessons for Low- and Middle-Income Countries

Antimicrobial resistance is a global health threat and efforts to mitigate it is warranted, thus the need for local antibiograms to improve stewardship. This study highlights the process that was used to develop an antibiogram to monitor resistance at a secondary-level health facility to aid empirical clinical decision making in a sub-Saharan African county. This retrospective cross-sectional descriptive study used 3 years of cumulative data from January 2016 to December 2018. Phenotypic data was manually imputed into WHONET and the cumulative antibiogram constructed using standardized methodologies according to CLSI M39-A4 guidelines. Pathogens were identified by standard manual microbiological methods and antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method according to CLSI M100 guidelines. A total of 14,776 non-duplicate samples were processed of which 1163 (7.9%) were positive for clinically significant pathogens. Among the 1163 pathogens, E. coli (n = 315) S. aureus (n = 232), and K. pneumoniae (n = 96) were the leading cause of disease. Overall, the susceptibility for E. coli and K. pneumoniae from all samples were: trimethoprim-sulfamethoxazole (17% and 28%), tetracycline (26% and 33%), gentamicin (72% and 46%), chloramphenicol (76 and 60%), and ciprofloxacin (69% and 59%), and amoxicillin/clavulanic (77% and 54%) respectively. Extended spectrum beta-lactamase (ESBL) resistance was present in 23% (71/315) vs. 35% (34/96) respectively. S. aureus susceptibility for methicillin was 99%. This antibiogram has shown that improvement in combination therapy is warranted in The Gambia.

Awareness of inappropriate use related to antimicrobial resistance among medical doctors by country economic status: A systematic review

BACKGROUND

Antimicrobial resistance (AMR) is promoted by inappropriate use and is a greater burden for low to middle income countries (LMIC) than high income countries (HIC).

OBJECTIVE

This systematic review aimed to compare the awareness of inappropriate use related to AMR among medical doctors from LMIC and HIC using published knowledge, attitude and practice (KAP) studies.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, sequential systematic literature search of PubMed and Web of Science databases for articles published since inception up to June 1, 2022 for KAP studies involving medical doctors. Using fifteen KAP items related to promoting AMR, data on proportion of participants responding affirmatively was extracted and reported using means, ranges and 95% confidence intervals (CI).

RESULTS

Forty-two studies met the inclusion criteria and involved 13,089 medical doctors from 11HIC and 21LMIC. All were cross-sectional studies, 71.4% involved non-probability sampling and 78.6% were of satisfactory quality. Knowledge items showed mean proportion of more medical doctors responding correctly. Similar affirmation trends were observed for attitude and prescribing practice items. Awareness appeared similar between medical doctors of the economic groups, except for a greater interest in training for LMIC (95.4%; 95%CI 93.0%, 97.9%) versus HIC (81.7%; 95%CI 65.6%, 97.9%). Countries with poor proportions were identified in both economic groups.

CONCLUSION

For identified studies, trends suggest good awareness among medical doctors of the known inappropriate use and perceived threat of AMR, as well as prescribing practices to reduce the risk of AMR. Trends were similar across HIC and LMIC; however, countries with evidence of poor awareness exist in both economic groups.

Antibiotic Prescription Audits Among Pediatric Outpatients With Acute Ailments in a Secondary Care Hospital During the COVID-19 Omicron Wave in Northern India

Background Antibiotics, as defined by the World Health Organization (WHO), are pharmaceuticals used to treat bacterial infections. There is growing recognition that inappropriate antibiotic prescription in children is linked to increasing rates of severe adverse drug events and higher medical expenditures. There are a few prescriptions audit studies from smaller cities in Northern India, especially those conducted during the COVID-19 pandemic when the unregulated private sector accounted for 90% of antibiotic sales and 75% of healthcare requirements. The study objectives were to determine the rate of outpatient antibiotic prescription and adherence to WHO drug indicators in prescriptions to pediatric outpatients in private healthcare facilities in India. Methodology This cross-sectional survey was conducted over three months (January to March 2022) in the outpatient setting of a private pediatric hospital in Kanpur, a city having a population of nearly three million population located in the state of Uttar Pradesh in India. Prescriptions of children aged <10 years with a history of onset of complaint <14 days were included in this audit. Prescriptions were numbered; data were collected using a specially designed semistructured, pretested prescription audit checklist; and the recommended WHO indicators were also calculated. Data were entered using CSPro (U.S. Census Bureau, Washington, DC, USA) and analyzed using STATA 15 (StataCorp LLC, College Station, TX, USA). Results This study observed an antibiotic prescription rate of 65.75%, which was higher than the WHO-recommended value, which might indicate indiscriminate usage of antibiotics in the setting. Out of the 144 antibiotic medications prescribed, none were generic and all the antibiotics were prescribed presumptively. The most commonly prescribed medicines were cefpodoxime, azithromycin, and ofloxacin, which were primarily used to treat cough and stomach infections. Conclusions This antibiotic audit conducted in a private hospital outpatient setting in a city in Northern India during the Omicron wave of the COVID-19 pandemic found nongeneric, predominantly oral, presumptive antibiotic prescriptions in nearly two out of three young pediatric patients. Improvement in prescribing practices through regulation, monitoring, and antibiotic stewardship in low-resource settings is urgently warranted to curb the impending global pandemic of antimicrobial resistance.

Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia: a questionnaire-based survey

OBJECTIVES

Antibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low-income and middle-income countries. This study aimed to understand the perceptions and views towards AMR, antibiotic prescribing practice and antimicrobial stewardship (AMS) among hospital physicians in Jakarta, Indonesia.

DESIGN

Cross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups.

SETTING

Six public and private acute-care hospitals in Jakarta in 2019.

PARTICIPANTS

1007 of 1896 (53.1% response rate) antibiotic prescribing physicians.

RESULTS

Physicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. EFA identified six latent factors (overall Crohnbach's α=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Factor scores differed across hospitals, departments, work experience and medical hierarchy.

CONCLUSIONS

AMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision making will be critical to change physicians' attitudes and develop context-specific AMS interventions.

Knowledge, Attitude and Beliefs of Nurses Regarding Antibiotic use and Prevention of Antibiotic Resistance

Introduction

Resistance to antibiotics is a threat confronting health care system worldwide. Nurses play a significant role in combating this threat.

Objectives

The present study examined the knowledge and attitude of nurses towards antibiotic use and prevention of antibiotic resistance.

Methods

The research involved a cross-sectional study conducted in a multi-cultural tertiary healthcare setting. The participants were 341 nurses. A structured self-administered questionnaire with a good validity and reliability (α = 0.7) was used.

Results

The nurses surveyed showed moderate awareness of antibiotic resistance and a fair attitude towards its prevention. There was no significant correlation of demographic features with their overall knowledge and attitude ( p > 0.05).

Conclusions

Nurses perform a crucial part in infection control, but often lack knowledge of methods to prevent antibiotic resistance. This paucity highlights the importance of tailored interventions to help nurses improve their awareness of antibiotic resistance and create a favorable attitude towards its prevention.

Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries

BACKGROUND

Routine microbiology results are a valuable source of antimicrobial resistance (AMR) surveillance data in low- and middle-income countries (LMICs) as well as in high-income countries. Different approaches and strategies are used to generate AMR surveillance data.

OBJECTIVES

We aimed to review strategies for AMR surveillance using routine microbiology results in LMICs and to highlight areas that need support to generate high-quality AMR data.

SOURCES

We searched PubMed for papers that used routine microbiology to describe the epidemiology of AMR and drug-resistant infections in LMICs. We also included papers that, from our perspective, were critical in highlighting the biases and challenges or employed specific strategies to overcome these in reporting AMR surveillance in LMICs.

CONTENT

Topics covered included strategies of identifying AMR cases (including case-finding based on isolates from routine diagnostic specimens and case-based surveillance of clinical syndromes), of collecting data (including cohort, point-prevalence survey, and case-control), of sampling AMR cases (including lot quality assurance surveys), and of processing and analysing data for AMR surveillance in LMICs.

IMPLICATIONS

The various AMR surveillance strategies warrant a thorough understanding of their limitations and potential biases to ensure maximum utilization and interpretation of local routine microbiology data across time and space. For instance, surveillance using case-finding based on results from clinical diagnostic specimens is relatively easy to implement and sustain in LMIC settings, but the estimates of incidence and proportion of AMR is at risk of biases due to underuse of microbiology. Case-based surveillance of clinical syndromes generates informative statistics that can be translated to clinical practices but needs financial and technical support as well as locally tailored trainings to sustain. Innovative AMR surveillance strategies that can easily be implemented and sustained with minimal costs will be useful for improving AMR data availability and quality in LMICs.

Knowledge, attitude and management of hearing screening in children among family physicians in the Kingdom of Saudi Arabia

BACKGROUND

Early detection and management of hearing loss are important to develop ordinary speaking language and academic skills during childhood. Lack of knowledge by either parents or health care providers could hinder the process of hearing loss diagnosis, such that the intervention will be less effective. There is little evidence about the knowledge and practice of family physicians regarding hearing screening in Saudi Arabia and worldwide.

OBJECTIVES

This study aimed to assess family physicians' knowledge, attitudes, and practices related to hearing loss in children. This in turn will help policy makers and educational institutions to establish and promote a program concerned with screening, diagnosis and intervention of paediatric hearing loss.

METHODS

A cross-sectional descriptive study enrolled 133 family physicians working at primary health centres in Saudi Arabia from March 2020 to September 2020. A self-reported questionnaire was used to assess the knowledge, attitudes, and practices of family physicians concerning hearing loss in children.

RESULTS

The majority of the participants were working under the umbrella of the Ministry of Health and around half of them did not screen any child for hearing loss. Despite that, 91.7% indicated the importance of neonatal hearing screening, 70.7% indicate infant candidacy for cochlear implant and only 33.1% know about the existence of the early hearing detection and intervention (EHDI) governmental program in kingdom of Saudi Arabia (KSA). Participants were able to identify factors associated with hearing loss such as a family history of hearing loss (85.6%), meningitis (75%) and craniofacial anomalies (51.5%). The most frequent specialists for patient referrals were ear nose and throat ENT (75.2%) and audiologists (67.7%).

CONCLUSION

This study shows that family physicians have good general background about the benefits of EHDI programs and the management of hearing loss in the paediatric population. However, it also indicated insufficient knowledge in other domains of hearing loss, including assessments and the presence of the EHDI governmental program in KSA. Further actions on the involvement of family physicians in the process of neonatal hearing screening, diagnosis and intervention for hearing impairment are needed.

Stewardship actions for device associated infections: An intervention study in the emergency intensive care unit

Improving the practices of antimicrobial use in hospitals, especially in developing countries, is a challenging duty.

OBJECTIVES

The aim of the study was to determine the effect of certain stewardship actions on the use of antibiotics for device-associated infections in the emergency intensive care unit in Egypt.

MEHODS

The intervention included establishment of AS team, design an antibiogram and preparation of antibiotic use guidelines, education, and infection prevention and control measures. Pre- and postinterventions surveys tookplace including: antibiotic prescription compliance, antibiotic cost, bacterial profile and antibiotic resistance rates.

RESULTS

Antibiotic prescription compliance improved, especially for prophylactic antibiotics prescription; in preintervention phase, 27.4% of cases received unindicated antibiotic prophylaxis vs 5.8% after intervention. A statistically significant decrease in cost after the intervention was reported (p = 0.04). Acinetobacter baumannii and Klebsiella pneumonia were the most frequently isolated pathogens (25.6%) and (21.8%) in pre and post-intervention phases respectively. A statistically significant decrease in the prevalence of MDR (X² = 11.9, p = 0.009) was observed. The most prevalent XDR is K-pneumonia (45% vs 17%) in phase 1&3. No pan drug-resistant isolates were detected.

CONCLUSION

Sound antibiotic guidelines coupled with effective infection control precautions and education would be a good intervention, particularly with a leadership commitment. The use of microbiology tests to direct prescribing decisions should be a underscored. Sustained research initiatives may support the proper implementation of AS programmes in limited resource settings.

Knowledge, attitude and antibiotic prescribing patterns of medical doctors providing free healthcare in the outpatient departments of public hospitals in Sierra Leone: a national cross-sectional study

Background

Antibiotic resistance is a global health crisis and irrational prescribing behaviour has been identified as a contributing factor. The current study aimed to assess the knowledge of, attitudes towards and practices regarding antibiotic prescribing of medical doctors providing free healthcare services in the outpatient departments of public hospitals in Sierra Leone. In addition, we evaluated prescribing patterns of antibiotics.

Methods

The study has two parts. First, we conducted a cross-sectional survey using a self-administered questionnaire to assess doctor’s knowledge of, attitudes towards and practices regarding prescribing antibiotics. Second, using patient medical records, we used the World Health Organization methodology on how to assess drug use in health facilities to evaluate prescribing patterns of antibiotics in four selected public hospitals in Sierra Leone.

Results

Of 130 administered questionnaires, 119 were returned, for a response rate of 91.5%. The majority of doctors (n=83 [69.7%]) agreed that amoxicillin is safe in the first 3 weeks of pregnancy and considered antibiotic resistance a global (n=108 [90.7%]) and national (n=97 [81.5%]) public health crisis. Less than a quarter of medical doctors agreed that antibiotics may speed up the recovery when added to malaria (n=25 [21%]) or cold and cough (n=81 [68%]) therapies. Prescribing pattern results show that children &lt;5 y of age (adjusted odds ratio 5.199 [confidence interval 2.743 to 9.855], p&lt;0.0001) were more likely to be prescribed an antibiotic than pregnant women/lactating mothers. Penicillins were the most commonly prescribed pharmacological class of antibiotics, with amoxicillin being the most commonly prescribed penicillin.

Conclusions

Doctors demonstrated a sound knowledge of antibiotics and antibiotics resistance, with a positive attitude towards prescribing antibiotics. However, the prescribing pattern of antibiotics was irrational, necessitating the need for the establishment of audit and feedback programmes such as antimicrobial stewardship programmes.

A comprehensive district-level laboratory intervention after the Ebola epidemic in Sierra Leone

Background

The 2014–2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms.

Objective

We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital’s general laboratory serving a population of over 500 000 in a rural district.

Methods

The intervention focused on (1) supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation.

Results

We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements.

Conclusion

This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers.

Opportunities and barriers to implementing antibiotic stewardship in low and middle-income countries: Lessons from a mixed-methods study in a tertiary care hospital in Ethiopia

Background

Global action plans to tackle antimicrobial resistance (AMR) include implementation of antimicrobial stewardship (AMS), but few studies have directly addressed the challenges faced by low and middle-income countries (LMICs). Our aim was to explore healthcare providers’ knowledge and perceptions on AMR, and barriers/facilitators to successful implementation of a pharmacist-led AMS intervention in a referral hospital in Ethiopia.

Methods

Tikur Anbessa Specialized Hospital (TASH) is an 800-bed tertiary center in Addis Ababa, and the site of an ongoing 4-year study on AMR. Between May and July 2017, using a mixed approach of quantitative and qualitative methods, we performed a cross-sectional survey of pharmacists and physicians using a pre-tested questionnaire and semi-structured interviews of purposively selected respondents until thematic saturation. We analyzed differences in proportions of agreement between physicians and pharmacists using χ² and fisher exact tests. Qualitative data was analyzed thematically.

Findings

A total of 406 survey respondents (358 physicians, 48 pharmacists), and 35 key informants (21 physicians and 14 pharmacists) were enrolled. The majority of survey respondents (>90%) strongly agreed with statements regarding the global scope of AMR, the need for stewardship, surveillance and education, but their perceptions on factors contributing to AMR and their knowledge of institutional resistance profiles for common bacteria were less uniform. Close to 60% stated that a significant proportion of S. aureus infections were caused by methicillin-resistant strains (an incorrect statement), while only 48% thought a large proportion of gram-negative infections were caused by cephalosporin-resistant strains (a true statement). Differences were noted between physicians and pharmacists: more pharmacists agreed with statements on links between use of broad-spectrum antibiotics and AMR (p<0.022), but physicians were more aware that lack of diagnostic tests led to antibiotic overuse (p<0.01). More than cost, fear of treatment failure and of retribution from senior physicians were major drivers of antibiotic prescription behavior particularly among junior physicians. All respondents identified high turnover of pharmacists, poor communication between the laboratory, pharmacists and clinicians as potential challenges; but the existing hierarchical culture and academic setting were touted as opportunities to implement AMS in Ethiopia.

Conclusions

This knowledge and perceptions survey identified specific educational priorities and implementation strategies for AMS in our setting. This is likely also true in other LMICs, where expertise and infrastructure may be lacking.

The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries-A systematic review

WHAT IS KNOWN AND OBJECTIVE

Inappropriate antibiotic use is the leading cause of antibiotic resistance especially in developing countries, where patient management is mainly based on the prescription of medicines due to deficiencies in diagnostic procedures. The objective of this study was to conduct a systematic review of studies on knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries.

METHODS

We used MEDLINE and EMBASE to conduct a systematic search for studies. We included papers that focused on health practitioners' knowledge on antibiotic use, local resistance and extent of the antibiotic resistance problem; the health practitioners' confidence in prescribing; commonly used guides; and recommendations to improve antibiotic prescribing. Studies that assessed other indicators were excluded. We assessed the quality of the individual studies using a previously published quality assessment tool. Data were summarized into proportions and means. We registered the review with PROSPERO, registration number CRD42018085664.

RESULTS AND DISCUSSION

We obtained 384 papers, 345 papers after deduplication, 28 relevant papers upon reviewing titles and abstracts, and 15 articles fulfilled our inclusion criteria upon full-text review. Most of the studies were of medium quality (ten), three were of low quality, and two were of high quality. An average of 80.9% of respondents correctly answered questions relating to antibiotic use, whereas 39.6% were aware of the local resistance patterns in their health facilities. Participants stated that antibiotic resistance was a general problem (75.2%), a global problem (84.7%), a national problem (88.0%), a problem in their health facilities (71.9%) and a problem in their daily practice (71.7%). Up to 78.2% of the participants reported that they were very confident or confident in antibiotic prescribing.

WHAT IS NEW AND CONCLUSION

There was a high reported proportion of participants with an apparently good level of knowledge on antibiotic use and a high level of confidence in antibiotic prescribing, but the reported level of knowledge on local antibiotic resistance was low. The analysis was limited by the low number of studies included, and most of them had a medium quality.

Antibiotic use on paediatric inpatients in a teaching hospital in the Gambia, a retrospective study

Background

Antibiotics are useful but increasing resistance is a major problem. Our objectives were to assess antibiotic use and microbiology testing in hospitalized children in the Gambia.

Methods

We conducted a retrospective analysis of paediatric inpatient data at The Edward Francis Small Teaching Hospital in Banjul, The Gambia. We extracted relevant data from the admission folders of all patients (aged > 28 days to 15 years) admitted in 2015 (January–December), who received at least one antibiotic for 24 h. We also reviewed the microbiology laboratory record book to obtain separate data for the bacterial isolates and resistance test results of all the paediatric inpatients during the study period.

Results

Over half of the admitted patients received at least one antibiotic during admission (496/917) with a total consumption of 670.7 Days of Antibiotic Therapy/1000 Patient-Days. The clinical diagnoses included an infectious disease for 398/496, 80.2% of the patients on antibiotics, pneumonia being the most common (184/496, 37.1%). There were 51 clinically relevant bacterial isolates, Klebsiella species being the most common (12/51, 23.5%), mainly from urine (11/12, 91.7%). Antibiotic resistance was mainly to ampicillin (38/51, 74.5%), mainly reported as Coliform species 11/51, 21.6%.

Conclusions

More than half of the admitted patients received antibiotics. The reported antibiotic resistance was highest to the most commonly used antibiotics such as ampicillin. Efforts to maximize definitive antibiotic indication such as microbiological testing prior to start of antibiotics should be encouraged where possible for a more rational antibiotic use.