High levels of surgical antibiotic prophylaxis: Implications for hospital-based antibiotic stewardship in Sierra Leone

Abstract

Objective: Despite the impact of inappropriate prescribing on antibiotic resistance, data on surgical antibiotic prophylaxis in sub-Saharan Africa are limited. In this study, we evaluated antibiotic use and consumption in surgical prophylaxis in 4 hospitals located in 2 geographic regions of Sierra Leone. Methods: We used a prospective cohort design to collect data from surgical patients aged 18 years or older between February and October 2021. Data were analyzed using Stata version 16 software. Results: Of the 753 surgical patients, 439 (58.3%) were females, and 723 (96%) had received at least 1 dose of antibiotics. Only 410 (54.4%) patients had indications for surgical antibiotic prophylaxis consistent with local guidelines. Factors associated with preoperative antibiotic prophylaxis were the type of surgery, wound class, and consistency of surgical antibiotic prophylaxis with local guidelines. Postoperatively, type of surgery, wound class, and consistency of antibiotic use with local guidelines were important factors associated with antibiotic use. Of the 2,482 doses administered, 1,410 (56.8%) were given postoperatively. Preoperative and intraoperative antibiotic use was reported in 645 (26%) and 427 (17.2%) cases, respectively. The most commonly used antibiotic was ceftriaxone 949 (38.2%) with a consumption of 41.6 defined daily doses (DDD) per 100 bed days. Overall, antibiotic consumption was 117.9 DDD per 100 bed days. The Access antibiotics had 72.7 DDD per 100 bed days (61.7%). Conclusions: We report a high rate of antibiotic consumption for surgical prophylaxis, most of which was not based on local guidelines. To address this growing threat, urgent action is needed to reduce irrational antibiotic prescribing for surgical prophylaxis.

The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study

“…The lack of protection against SSIs by the prescribed antibiotics could be explained by the fact that, in these hospital settings, the wrong antibiotics are used at the wrong time for surgical prophylaxis. 28 Risk factors for SSI in this study are older age, abdominal surgeries, duration of preoperative admission time more than 24 h, the presence of more than two surgeons or one scrub nurse, contaminated wounds, placement of nasogastric (NG) tube or surgical drain, the presence of comorbidities and surgery duration. This pattern is similar to the studies in sub-Saharan Africa 18,25,29 and elsewhere in Israel 30 and the United States.…”

“…The lack of protection against SSIs by the prescribed antibiotics could be explained by the fact that, in these hospital settings, the wrong antibiotics are used at the wrong time for surgical prophylaxis. 28 …”

High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study

“…Unlike a bibliometric review of data in Bahrain, which reported mostly 'high' priority pathogens, 71% of the isolates in this study are 'critical' priority pathogens [30]. The misuse and over use of the third-generation cephalosporins especially ceftriaxone, and the challenges of hand hygiene practices in these hospitals may explain this level of critical priority pathogens [31][32][33][34]. Unfortunately, in low-income countries like Sierra Leone, most of the antibiotics available are sold or dispensed over the counter without a prescription.…”

Establishing an Antimicrobial Stewardship Program in Sierra Leone: A Report of the Experience of a Low-Income Country in West Africa

“…The IPC, WASH, and AMS broader committee developed terms of reference for the AMS subcommittee to support and define its operations. The need to review the surgical prophylaxis guidelines was identified through previous research at the hospital and the recent GPPS results [ 12 , 13 ]. It was decided to bring in various stakeholders for the review of the surgical prophylaxis guidelines.…”

“…This situation, and the fact that our previous work reported many challenges with rational antibiotic prescribing prompted us to set up the only existing AMS program at Sierra Leone’s national referral hospital [ 12 , 13 ]. In this article, we aim to describe the processes of establishing and operationalizing an AMS program in the national referral hospital of Sierra Leone.…”