Background: Amputation is the removal of whole or part of a limb, often as a life saving measure. It is a mutilating surgical procedure altering the body image and producing severe functional deficit. It is a common orthopedic surgical procedure performed worldwide. Aims and objectives: The aim of this study was to determine the pattern and indications for amputation in Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; between January 2008 and December 2014, in a bid to proffer preventive measures. Patients and methods: This was a retrospective study of consecutive patients who had major limb amputations at the Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; between January 2008 and December 2014. Case notes of patients were retrieved with relevant information extracted and analyzed. Results: A total of 112 amputations were studied. The age range of patients was between 3-89 years. Amputation in 23.5% of patients was due to trauma, followed by diabetic foot gangrene in 21% of cases. About 42.9% of the amputations were above knee, followed by below knee amputations in 37% of cases. The lower limbs were involved in 84.8% of cases and upper limbs in 15.2% of cases. Conclusion: Trauma was the most predominant indication for amputation in this study. This was followed by diabetic foot gangrene. This is usually due to the high rate of road traffic accidents and consequent mismanagement by traditional bone setters.

Background:Wounds are commonly encountered in the clinical practice. Microbacterial colonization and infection negatively affect wound outcomes. With increasing emergence of antibiotic-resistant strains, it is essential to determine local patterns of wound microbiological profile and antibiotic susceptibility to guide rational empirical antibiotic use.Materials and Methods:Consecutive patients who presented to the plastic surgery unit were recruited to the study over a 6-month period. Wound swab cultures were performed at presentation using standard protocols and media. The wound swab was performed by the Levine technique and data were analyzed using a statistical software package.Results:Eighty-five microbial isolates were obtained from the eighty patients (55 males and 25 females) recruited. Gram-positive isolates were 35 (41.2%) and Gram-negative were 50 (58.8%). There was equal distribution of acute and chronic wounds. Pseudomonas aeruginosa was the most common isolate at 30.6%, followed by Staphylococcus aureus (27.1%), Escherichia coli (9.4%), Streptococcus species (8.2%), and Morganella morganii (7.1%). The isolates demonstrated resistance to amoxicillin-clavulanate, ampicillin, cloxacillin, cefuroxime, ceftazidime; low-to-moderate sensitivity to erythromycin, gentamicin, streptomycin, tetracycline, ciprofloxacin, and ofloxacin; and a moderate sensitivity to ceftriaxone and a high sensitivity to imipenem. There was significant difference in antibiotic resistance patterns between Gram-positive isolates from acute and chronic wound infections but not for acute and chronic wound Gram-negative isolates.Conclusion:Most of the microbial isolates, particularly the Gram-negative isolates demonstrated low sensitivity to commonly used antibiotics and moderate-to-high sensitivity to less commonly used newer antibiotics.

Background: Empirical use of antibiotics is a standard practice in the treatment of infections worldwide. However, its over utilization without subsequent culture and antibiotic susceptibility testing could be a major driver of resistance.Over reliance on empirical antibiotherapy is common in most developing countries where antibiotic policies and availability or utilization of clinical microbiology laboratory are suboptimal. A standardized approach to point prevalence survey (PPS) on antimicrobial use (AMU) in hospitals was employed to assess the antimicrobial prescribing practices in Federal Teaching Hospital Gombe (FTHG), Nigeria.Methodology: A PPS was conducted in April 2019 at FTHG by recruiting all in-patients present in the hospital on the day of survey. Data obtained from patients’ records included details of the type and indication for antibiotherapy. A customized online application developed by the University of Antwerp (www.global-pps.be) was used for data-entry, validation, analysis and reporting.Results: Of the total 326 patients who were on admission on the day of survey, 70.6% and 73.4% were on at least one antibiotic in adult and paediatric wards respectively. Most commonly used antibiotics include beta lactams such as cephalosporins (29.2%) and penicillins (22.8%), fluoroquinolones (12.4%), aminoglycosides (9.1%) and macrolides (3.4%). Among patients on antibiotics, route of  administration was mainly parenteral (71.6%) while 44.8% were on more than one antibiotic. Overall, 91.3% of the antibiotic treatments were empirical with adults, children and neonates accounting for 96.4%, 77.6% and 100.0% respectively. Empirical antibiotic use is also high in medical wards (86.3%), surgical wards (89.9%) and intensive care unit (100.0%).Conclusion: There is predominance and over-reliance on empirical antibiotherapy in our hospital. It further exposes the poor utilization of clinical microbiology laboratory and the potential for development of antibiotic resistance with resultant increase in morbidity/mortality and poor patient safety. There is need for further studies to highlight the dangers of over-reliance on empirical antibiotherapy and herald improvement in development and implementation of antibiotic stewardship programme. Keywords: Empirical antibiotherapy, antimicrobial resistance, point prevalence survey, antimicrobial stewardship   French title:L'antibiothérapie empirique comme moteur potentiel de la résistance aux antibiotiques: observations d'une enquêteponctuelle de prévalence de la consommation et de la résistance aux antibiotiques à Gombe, au Nigéria   Contexte: L'utilisation empirique d'antibiotiques est une pratique courante dans le traitement des infections dans le monde entier. Cependant, sa surutilisation sans culture ultérieure ni test de sensibilité aux antibiotiques pourrait être un facteur majeur de résistance. Le recours excessif à l'antibiothérapie empirique est courant dans la plupart des pays en développement où les politiques d'antibiotiques et la disponibilité ou l'utilisation du laboratoire de microbiologie clinique sont sous-optimales. Une approche standardisée de l'enquête de prévalence ponctuelle (PPS) sur l'utilisation des antimicrobiens (AMU) dans les hôpitaux a été utilisée pour évaluer les pratiques de prescription d'antimicrobiens au Federal Teaching Hospital Gombe (FTHG), au Nigéria.Méthodologie: Un PPS a été réalisé en avril 2019 au FTHG en recrutant tous les patients hospitalisés présents à l'hôpital le jour de l'enquête. Les données obtenues à partir des dossiers des patients comprenaient des détails sur le type et l’indication de  l’antibiothérapie. Une application en ligne personnalisée développée par l'Université d'Anvers (www.global-pps.be) a été utilisée pour la saisie, la validation, l'analyse et le reporting des données.Résultats: Sur les 326 patients au total qui étaient admis le jour de l'enquête, 70,6% et 73,4% prenaient au moins un antibiotique dans les services pour adultes et pédiatriques respectivement. Les antibiotiques les plus couramment utilisés comprennent les bêta-lactamines telles que les céphalosporines (29,2%) et les pénicillines (22,8%), les fluoroquinolones (12,4%), les aminosides (9,1%) et les macrolides (3,4%). Parmi les patients’ sous antibiotiques, la voie d'administration était principalement parentérale (71,6%) tandis que 44,8% prenaient plus d'un antibiotique. Dans l'ensemble, 91,3% des traitements antibiotiques étaient empiriques, les adultes, les enfants et les nouveau-nés représentant respectivement 96,4%, 77,6% et 100,0%. L'utilisation empirique d'antibiotiques est également élevée dans les services médicaux (86,3%), les services chirurgicaux (89,9%) et les unités de soins intensifs (100,0%).Conclusion: Il y a une prédominance et une dépendance excessive à l'antibiothérapie empirique dans notre hôpital. Il expose en outre la mauvaie utilisation du laboratoire de microbiologie clinique et le potentiel de développement d'une résistance aux antibiotiques avec une augmentation résultante de la morbidité/mortalité et une mauvaise sécurité des patients. Des études supplémentaires sont nécessaires pour mettre en évidence les dangers d'une dépendance excessive à l'antibiothérapie empirique et annoncer une amélioration dans le développement et la mise en œuvre d'un programme de gestion des antibiotiques. Mots clés: antibiothérapie empirique, résistance aux antimicrobiens, enquête ponctuelle de prévalence, gestion des antimicrobiens  

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