Antibiotic use among surgical inpatients at a tertiary health facility: a case for a standardized protocol for presumptive antimicrobial therapy in the developing world

Abstract

Summary 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.

Improving Antibiotic Use in Surgical Care: Impact of Clinical Pharmacist Interventions on Optimizing Patient Therapy

“…The most common use for which patients were prescribed antibiotics was for prophylaxis (47%), followed by empirical therapy (44%), as most cases had undergone surgical intervention. The findings were similar to studies conducted in India and Nigeria (3,11) . Of the 1085 antibiotics prescribed, 96.13% were injectables, which was found to be higher when compared to a study in Nigeria, where only 58.7% of antibiotics were injectables.…”

“…Of the 1085 antibiotics prescribed, 96.13% were injectables, which was found to be higher when compared to a study in Nigeria, where only 58.7% of antibiotics were injectables. This difference might be due to the following study design, i.e., point prevalence survey (11) . The characteristics of antibiotic prescriptions in the study population are depicted in Table 2.…”

Point prevalence survey of antimicrobial consumption and resistance: 2015-2018 longitudinal survey results from Nigeria

“…Ethical clearance for the conduct of the study was obtained from the various local research and ethics committees of the participating hospitals. There was no direct contact with patients, and no identifiers such as name, phone number and address were among these Nigerian hospitals is similar to the high rates reported in other studies in Nigeria and other tropical countries (12,14,15). This could be as a result of the generally low awareness on appropriate antibiotic use and AMR, high over-the-counter use of antibiotics, low level of implementation of AMS programmes such as awareness campaigns in the regions and lack of stringent guidelines and policy for AMU.…”

A Multi-Center Study to Measure the Performance of Antimicrobial Stewardship in 14 Hospitals Across Nigeria: Needs Assessment

“…The health system has not identified AMS as a priority, hence the absence of policy and lack of resource allocation. This level of practice could explain the high level of antimicrobial use earlier reported in some Nigerian hospitals (Nnadozie, et al, 2020;Umeokonkwo, et al, 2019;Oduyebo, et al, 2017;Abubakar, 2020).…”