Ceftriaxone use in a tertiary care hospital in Kilimanjaro, Tanzania: A need for a hospital antibiotic stewardship programme

Abstract

Excessive use of antibiotics, especially watch group antibiotics such as ceftriaxone leads to emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries (LMICs), antibiotics are overused but data on consumption is scarcely available. We aimed at determining the extent and predictors of ceftriaxone use in a tertiary care university teaching hospital in Kilimanjaro, Tanzania. A hospital-based cross-sectional study was conducted from August 2013 through August 2015. Patients admitted in the medical, surgical wards and their respective intensive care units, receiving antimicrobials and other medications for various ailments were enrolled. Socio-demographic and clinical data were recorded in a structured questionnaire from patients’ files and logistic regression was performed to determine the predictors for ceftriaxone use. Out of the 630 patients included in this study, 322 (51.1%) patients were on ceftriaxone during their time of hospitalization. Twenty-two patients out of 320 (6.9%) had been on ceftriaxone treatment without evidence of infection. Ceftriaxone use for surgical prophylaxis was 44 (40.7%), of which 32 (72.7%) and 9 (20.5%) received ceftriaxone prophylaxis before and after surgery, respectively. Three (6.8%) received ceftriaxone prophylaxis during surgery. Predicting factors for that the health facility administered ceftriaxone were identified as history of any medication use before referral to hospital [OR = 3.4, 95% CI (1.0–11.4), p = 0.047], bacterial infection [OR = 18.0, 95% CI (1.4–225.7, p = 0.025)], surgical ward [OR = 2.9, 95% CI (0.9–9.4), p = 0.078] and medical wards [OR = 5.0, 95% CI (0.9–28.3), p = 0.070]. Overall, a high ceftriaxone use at KCMC hospital was observed. Antimicrobial stewardship programs are highly needed to monitor and regulate hospital antimicrobial consumption, which in turn could help in halting the rising crisis of antimicrobial resistance.

Point prevalence survey of antimicrobial use in three hospitals in North-Eastern Tanzania

“…Ceftriaxone was prescribed for both community and hospital-acquired infections, as well as for surgical prophylaxis. The frequent use of this broad-spectrum antibiotic in KCMC and hospitals across sub-Saharan Africa was reported earlier [18,19]. Injudicious use of ceftriaxone may contribute to the high burden of AMR, including nosocomial infections with extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae, and complicate empirical treatment of severe bacterial infections.…”

Point Prevalence survey of antimicrobial use in three hospitals in North-eastern Tanzania

“…Ceftriaxone was prescribed for both community and hospital-acquired infections, as well as surgical prophylaxis. The frequent use of this broad-spectrum antibiotic in KCMC and hospitals across sub-Saharan Africa was reported earlier [13] [14]. Injudicious use of ceftriaxone may contribute to the high burden of AMR, including nosocomial infections with extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae, and complicate empirical treatment of severe bacterial infections.…”

The high resistance of bacteria to clindamycin and cefepime: a call to revisit antibiotics reserved for use at tertiary hospitals in Tanzania

“…It has been documented that the Enteroccoci are intrinsically resistant to clindamycin, which could explain the observed resistant pattern (8,28). Being normal flora of the gastrointestinal tract with frequent contact to antibiotics which are, in high rate misused, could increase the proportion of resistant Enterococci (9,29,30). Also, the previous use of clindamycin as additive drug to quinine for treatment of uncomplicated malaria in pregnant could have accelerated the resistance of this antibiotic (31).…”

“…The high proportion of resistant Gram negative bacteria to fourth generation cephalosporin (cefepime) could be suggestive of bacteria adaptive mechanisms by cross-resistance between generations of the same antibiotic class (32). The overuse and irrational use of antibiotics especially third generation cephalosporin (ceftriaxone) could contribute to failure of subsequent cephalosporin generations (29,30,33).…”