Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications

Okoth, Caleb; Opanga, Sylvia; Okalebo, Faith A.; Oluka, Margaret; Kurdi, Amanj; Godman, Brian

doi:10.1080/21548331.2018.1464872

Cited by 79 publications

(89 citation statements)

References 39 publications

(35 reference statements)

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“…The results of the PPS in three hospitals from different levels of healthcare in Tanzania showed a prevalence of antibiotic use in hospital inpatients of 44%. This is comparable to results from African countries in the Global PPS (50%) as well as surveys from individual sub-Saharan African countries such as Botswana 70.6% [18] and Kenya 67.7% [15].…”

Section: Discussionsupporting

confidence: 83%

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

Horumpende

Mshana

Mouw

et al. 2020

Preprint

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Background: Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania. Methods: A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 hours and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day. Results: A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n=94, 29.8%), metronidazole (n=79, 23.9%) and other antibiotics belonging to the penicillin class (n=89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases.Conclusion: Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.

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Section: Discussionsupporting

confidence: 83%

“…Recently, a PPS performed among hospitals throughout Botswana found a high prevalence (70.6%) of antimicrobial use, as well as different areas for improvement [14]. A PPS performed in a referral hospital in Kenya reported comparable ndings [15].…”

Section: Introductionmentioning

confidence: 95%

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

Horumpende

Mshana

Mouw

et al. 2020

Preprint

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“…However, again this needs further investigation [56]. In this study, the highest use of antibiotics was seen in ICU which was similar to the results observed in Kenya and Switzerland [35,57], with high rates of antibiotic use in ICUs seen in the recent PPS study in Pakistan [37]. Overall, the extensive use of broad-spectrum antibiotics in de nitive treatment could be explained by high bacterial resistance rates [58].…”

Section: Discussionsupporting

confidence: 79%

“…Choudhary et al also found that a change of therapy was only undertaken in 20.9% of positive culture patients. We are aware that there can be challenges with ordering culture reports among hospitals in LMICs with high rates of empiric prescribing [34][35][36][37][38]. However, we are aware that the results of culture reports can help reduce the number of antibiotics prescribed, with Berild et demonstrating a 22% reduction consumption of antibiotics with de nitive treatment [25].…”

Section: Introductionmentioning

confidence: 99%

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Altaf

Akhtar

Ahmad

et al. 2020

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Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empirical therapy to be adjusted according to the result of culture sensitivity reports.Objective: To find the impact of culture sensitivity reports on the use of antibiotics and cost in a leading tertiary care hospital in Lahore.Methods: This prospective observational study was carried out in Ghurki trust teaching hospital. A total of 465 positive culture patients were taken over an 8 month study period using convenient sampling techniques and immediately sent to the microbiology laboratory for pathogen identification and susceptibility testing using the Kirby-Bauer disc diffusion method. Additional data was collected from the patient medical file which included demographic data, sample type, causative microbe, anti-microbial treatment given in empirical and definitive treatment as well as medicine costs. Results: Total of 497 isolates were detected from the 465 patient samples, which included 309 gram-negative rods and 188 gram-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was MSSA (28.4%) and Gram-negative was E. coli (23.8%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the A. baumannii isolates were resistant to carbapenems. Gram-positive microorganism showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics in empirical therapy were cefoperazone+sulbactam, ceftriaxone, amikacin, vancomycin and metronidazole whereas high use of linezolid, clindamycin, meropenem and piperacillin + tazobactam was evidenced in definitive treatment. Empiric therapy was adjusted in 222 (71.8%) cases of Gram-negative infections and 131 (69.6%) cases of gram-positive infections (p-value <0.0001). Compared with empirical therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average costs of antibiotics in definitive treatment was less than the empirical treatment (8.2%) and the length of hospitalization also decreased.Conclusion: Culture sensitivity reports helped reduce antibiotic utilization, hospital stay and costs as well as helping select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs and the development of hospital antibiotic guidelines within the hospital to reduce future unnecessary prescribing of broad-spectrum antibiotics.

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“…Half of the respondents stated that therapeutic interchange policies were the responsibility of PTCs, with PTCs generally considered the most ideal setting for such programmes, which is encouraging as they can ensure that any guidelines are based on scientific evidence and any national Essential Medicine List [17,[37][38][39]. Several actions were reported as part of the pharmacist's practice during substitution (Table 5) including communication with other health professionals and providing information on available alternatives.…”

Section: Discussionmentioning

confidence: 99%

Availability and Use of Therapeutic Interchange Policies in Managing Antimicrobial Shortages among South African Public Sector Hospitals; Findings and Implications

et al. 2019

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Background: Therapeutic interchange policies in hospitals are useful in dealing with antimicrobial shortages and minimising resistance rates. The extent of antimicrobial shortages and availability of therapeutic interchange policies is unknown among public sector hospitals in South Africa. This study aimed to ascertain the extent of and rationale for dealing with antimicrobial shortages, describe policies or guidelines available, and the role of pharmacists in the process. Methods: A quantitative and descriptive study was conducted with a target population of 403 public sector hospitals. Data were collected from hospital pharmacists using an electronic questionnaire via SurveyMonkeyTM. Results: The response rate was 33.5% and most (83.3%) hospitals had experienced shortages in the previous six months. Antimicrobials commonly reported as out of stock included cloxacillin (54.3%), benzathine benzylpenicillin (54.2%), and erythromycin (39.6%). Reasons for shortages included pharmaceutical companies with supply constraints (85.3%) and an inefficient supply system. Only 42.4% had therapeutic interchange policies, and 88.9% contacted the prescriber, when present, for substitution. Conclusions: Antimicrobial shortages are prevalent in South African public sector hospitals with the most affected being penicillins and cephalosporins. Therapeutic interchange policies are not available at most hospitals. Effective strategies are required to improve communication between pharmacists and prescribers to ensure that safe, appropriate, and therapeutically equivalent alternatives are available.

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Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications

Cited by 79 publications

References 39 publications

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

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

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Availability and Use of Therapeutic Interchange Policies in Managing Antimicrobial Shortages among South African Public Sector Hospitals; Findings and Implications

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