Assessment of blood cultures and antibiotic susceptibility testing for bacterial sepsis diagnosis and utilization of results by clinicians in Benin: A qualitative study

Abstract

ObjectivesWe assessed the current status of blood culture and antibiotic susceptibility testing (AST) practices in clinical laboratories in Benin, and how the laboratory results are used by physicians to prescribe antibiotics.MethodsThe qualitative study covered twenty-five clinical laboratories with a bacteriology unit and associated hospitals and pharmacies. Altogether 159 laboratory staff, physicians and pharmacists were interviewed about their perceptions of the state of laboratory diagnostics related to sepsis and the use of antibiotics. Face-to-face interviews based on structured questionnaires were supported by direct observations when visiting five laboratories in across the country.ResultsOnly 6 laboratories (24%) conducted blood cultures, half of them with a maximum of 10 samples per month. The most common gram-negative bacteria isolated from blood cultures were: Escherichia coli, Salmonella spp. and Salmonella enterica serovar Typhi while the most common gram-positives were Enterococcus spp. and Staphylococcus aureus. None of the laboratories listed Klebsiella pneumoniae among the three most common bacteria isolated from blood cultures, although other evidence indicates that it is the most common cause of sepsis in Benin. Due to limited testing capacity, physicians most commonly use empirical antibiotic therapy.ConclusionsMore resources are needed to develop laboratory testing capacity, technical skills in bacterial identification, AST, quality assurance, and communication of results must be strengthened.

Strengthening clinical bacteriology laboratory diagnostics to combat sepsis and antimicrobial resistance in Benin: a train-the-trainer approach

“…Before starting the training activities, a survey was conducted using face-to-face interviews with laboratory staff and physicians across the country to assess the training needs (14). The survey identified deficiencies in the knowledge and practices of laboratory technicians regarding culturing blood samples, identifying pathogens causing sepsis and AST.…”

“…The evaluation was carried out in the actual work situation and lasted 4 h in each laboratory. We had previously collected baseline information from the laboratories (14), which allowed us to assess the positive changes in the practices related to external and internal quality assurance, a blood culture, bacterial identification methods and AST. During the visits, the evaluators noticed that the new SOPs produced by the trainers were in effective use.…”

“…Therefore, nationally uniform training based on standardized techniques is needed to improve the accuracy of laboratory diagnostics (12,15). Reliable test results are essential for both targeted treatment of patients and empiric treatment when the prevalent AMR characteristics of the sepsis-causing organisms are known in the region (14).…”

Investigating Catheter-Related Infections in Southern Benin Hospitals: Identification, Susceptibility, and Resistance Genes of Involved Bacterial Strains

“…Studies in Benin have revealed poor hygiene in health facilities [ 13 , 14 , 15 ] and a lack of training of medical personnel in invasive procedures. To address this issue, various intervention projects in Benin aim to improve the technical skills of medical personnel [ 16 ]. However, there is no specific study that has analyzed the impact of these factors on the occurrence of infections.…”