Antimicrobial usage at a large teaching hospital in Lusaka, Zambia

Abstract

Antimicrobial resistance is a growing global health concern. Antimicrobial stewardship (AMS) curbs resistance rates by encouraging rational antimicrobial use. However, data on antimicrobial stewardship in developing countries is scarce. The objective of this study was to characterize antimicrobial use at the University Teaching Hospital (UTH) in Lusaka, Zambia as a guiding step in the development of an AMS program. This was a cross-sectional, observational study evaluating antimicrobial appropriateness and consumption in non-critically ill adult medicine patients admitted to UTH. Appropriateness was defined as a composite measure based upon daily chart review. Sixty percent (88/146) of all adult patients admitted to the general wards had at least one antimicrobial ordered and were included in this study. The most commonly treated infectious diseases were tuberculosis, pneumonia, and septicemia. Treatment of drug sensitive tuberculosis is standardized in a four-drug combination pill of rifampicin, isoniazid, pyrazinamide and ethambutol, therefore appropriateness of therapy was not further evaluated. The most common antimicrobials ordered were cefotaxime (n = 45), ceftriaxone (n = 28), and metronidazole (n = 14). Overall, 67% of antimicrobial orders were inappropriately prescribed to some extent, largely driven by incorrect dose or frequency in patients with renal dysfunction. Antimicrobial prescribing among hospitalized patients at UTH is common and there is room for optimization of a majority of antimicrobial orders. Availability of certain antimicrobials must be taken into consideration during AMS program development.

Seasonality and Annual Utilization Patterns of Antibacterials at Muhimbili National Hospital, Dar es Salaam, Tanzania: A 2015 Monthly Survey

“…In our study, cephalosporins were the third most utilized group considering ATC level 3 as opposed to the study in Zambia (32) and Pakistan (33), where there was high use of cephalosporin prompting ASP measures in that settings.…”

“…Frequent use of cephalosporins was observed in Ethiopia (21). High use of metronidazole was also noted in a study in Karthoum (22) and Lusaka Zambia (32) and Pakistan (33).…”

Antibiogram Development in the Setting of a High Frequency of Multi-Drug Resistant Organisms at University Teaching Hospital, Lusaka, Zambia

“…While we could not test for broad-spectrum beta-lactamase production, the high rates of resistance to 3 rd generation cephalosporins, 41.4% susceptibility of E. coli and 15.6% susceptibility of K. pneumomiae to ceftriaxone, respectively, indicate this is common. This is not entirely unexpected as 3 rd generation cephalosporins are the most commonly utilized antibiotics at UTH, driving the development of ESBL-producing organisms [27]. Studies from SSA reveal high rates of ESBL production [16,28] or resistance to 3 rd generation cephalosporins [2][3][4][5][6][7][8][9].…”

Novel chromosomal insertions of ISEcp1-blaCTX-M-15 and diverse antimicrobial resistance genes in Zambian clinical isolates of Enterobacter cloacae and Escherichia coli

“…Moreover, a study conducted at the UTH reported a 53.7% antibiotic prescription rate [ 64 ], clearly surpassing the 30% rate recommended by the WHO [ 65 ]. Most serious bacterial infections among UTH inpatients are treated with third-generation cephalosporins (e.g., cefotaxime) [ 66 ], while quinolones (e.g., ciprofloxacin) are commonly used for outpatient infections [ 64 ]. Our results show that nearly 90% of cefotaxime-resistant strains were also resistant to quinolones.…”