Multiple challenges of antibiotic use in a large hospital in Ethiopia – a ward-specific study showing high rates of hospital-acquired infections and ineffective prophylaxis

Abstract

BackgroundThis project aims to study the use of antibiotics in three clinical wards in the largest tertiary teaching hospital in Ethiopia for a period of 1 year. The specific aims were to assess the prevalence of patients on antibiotics, quantify the antibiotic consumption and identify the main indications of use.MethodThe material was all the medical charts (n = 2231) retrieved from three clinical wards (internal medicine, gynecology/obstetrics and surgery) in Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa between September 2013 and September 2014. Data collection was performed manually by four pharmacists.ResultsEach medical chart represented one patient. About 60% of the patients were admitted to internal medicine, 20% to each of the other two wards. The number of bed days (BD) was on average 16.5. Antibiotics for systemic use were prescribed to 73.7% of the patients (on average: 2.1 antibiotics/patient) of whom 86.6% got a third or fourth generation cephalosporin (mainly ceftriaxone). The average consumption of antibiotics was 81.6 DDD/100BD, varying from 91.8 in internal medicine and 71.6 in surgery to 47.6 in gynecology/obstetrics. The five most frequently occurring infections were pneumonia (26.6%), surgical site infections (21.5%), neutropenic fever (6.9%), sepsis (6.4%) and urinary tract infections (4.7%). About one fourth of the prescriptions were for prophylactic purposes. Hospital acquired infections occurred in 23.5% of the patients (353 cases of surgical site infection). The prescribing was based on empirical treatment and sensitivity testing was reported in only 3.8% of the cases.ConclusionsIn the present study from three wards in the largest tertiary teaching hospital in Ethiopia, three out of four patients were prescribed antibiotics, primarily empirically. The mean antibiotic consumption was 81.6 DDD/100BD. Surgical site infections constituted a large burden of the infections treated in the hospital, despite extensive prescribing of prophylaxis. The findings show the need to implement antibiotic stewardship programs in Ethiopian hospitals with focus on rational prescribing, increased sensitivity testing and better procedures to prevent hospital acquired infections.

Use of Monitoring Indicators in Hospital Management of Antimicrobials

“…Respiratory infections prevailed in the medical clinic and pneumology/infectology (22.4% and 39.1%, respectively), this data re ects the characteristics of the wards described, and corroborate with studies that describe that approximately 50% of the use of antimicrobials is used in the treatment of respiratory and urinary infections [4,8,9,13]. In the ICU the main diagnostic indications were for the treatment of sepsis (34.1%).…”

“…A large study carried out by Versporten [7], when evaluating the use of antimicrobials in patients admitted to adult hospitals in 53 countries, identi ed, in Latin America, the average use of 36.8%, ranging from 32.5% to 43.4%. However, the literature describes a broader range that extends from 22% to 76% of hospitalized patients receiving at least one antimicrobial during hospital stay [1,4,8,9,12]. Even though the result, observed here, is within the presented range, these studies demonstrate variations that may be related to the type of care provided in each hospital, where the need for antimicrobial indication may be higher or lower.…”

“…The predominance of the use of ATMs in the ICU was also observed in a study of one-off prevalence on health-related infections in Austria, in which 67.9% of patients in this ward were exposed to some antimicrobial, other studies indicate variations from 55.1% to 57% [1,4,7]. Variations are also observed in the medical clinic (31.8% -73.2%), and in the surgical clinic (37.3% to 84.1%) [1,7,8,13]. The fragile conditions with which patients arrive at the ICUs explain the greater frequency of infections and, consequently, the greater need for antibiotic therapy in this ward.…”

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

“…Prescribing broad-spectrum antibiotics empirically and for prolonged duration is a common and enduring practice in many LRS. In Ethiopia, up to 85% of hospitalized patients are on antibiotics on any given day (15). Further, prescriptions tend to follow patterns whereby the latest antibiotics introduced into the country gradually replace previous generations of broad-spectrum antibiotics, which themselves replaced firstline agents only a few years prior.…”

Antibiotic consumption study in two hospitals in Asmara from 2014 to 2018 using WHO’s defined daily dose (DDD) methodology

“…The total antibiotic consumption in HMW (158.5 DDD/100-BD) was higher than the 117.6 DDD/ 100-BD reported from a similar secondary level hospital study in New Zealand [26]. The mean antibiotic consumption in OMW was 79.5 DDD/100-BD lower from the tertiary medical wards in Ethiopia 91.8 DDD/100-BD [27] and Zurich 110.4 DDD/100-BD [18]. However, antibiotic consumption in OMW was higher than the 72.3 DDD/100-BD reported in Netherlands [23].…”