Prophylactic antibiotics to prevent surgical site infections in Botswana: findings and implications

Mwita, Julius Chacha; Souda, Sajini; Magafu, Mgaywa Gilbert Mjungu Damas; Massele, Amos; Godman, Brian; Mwandri, Michael

doi:10.1080/21548331.2018.1450605

Cited by 46 publications

(39 citation statements)

References 34 publications

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“…Inappropriate ceftriaxone use can lead to the emergence of multidrug-resistant strains if not addressed [55,56]. There is also concern that antibiotics for surgical prophylaxis were given for more than one day (97.4%), which is against current guidance as this can increase AMR rates [57,58]; however, this is similar to the situation seen in other countries [36,46,59]. The threat of surgical site infections should not be ignored while following guidelines [60,61].…”

Section: Discussionmentioning

confidence: 99%

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

Saleem

Hassali

Versporten

et al. 2019

Expert Review of Anti-infective Therapy

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Objective:In line with the recent global action plan for antimicrobial resistance, the first time such a comprehensive survey has been undertaken in Pakistan, sixth most populous country. Method:This point prevalence survey (PPS) was conducted in 13 hospitals among 7 different cities of Pakistan. The survey included all inpatients receiving an antibiotic on the day of PPS. A web-based application was used for data entry, validation, and reporting as designed by the University of Antwerp. Results:Out of 1954 patients, 1516 (77.6%) were treated with antibiotics. Top three most reported indications for antibiotic use were prophylaxis for obstetrics or gynaecological indications (16.5%) and gastrointestinal indications (12.6%) and lower respiratory tract infections (12.0%). Top three most commonly prescribed antibiotics were ceftriaxone (35.0%), metronidazole (16.0%) and ciprofloxacin (6.0%). Out of total indications, 34.2% of antibiotics were prescribed for community-acquired infections (CAI), 5.9% for healthcare-associated infections (HAI), and 57.4% for either surgical or medical prophylaxis. Of total surgical prophylaxis, 97.4% of antibiotics were given for more than one day. Conclusion:Study concluded that unnecessary prophylactic antibiotic use is extremely high and broad-spectrum prescribing is common. There is a considerable need to work on a national action plan of Pakistan on antibiotic resistance.

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Section: Discussionmentioning

confidence: 99%

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

Saleem

Hassali

Versporten

et al. 2019

Expert Review of Anti-infective Therapy

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“…Nonsurgical patients tend to stay longer in the ICU than surgical patients. Surgical site infections (SSIs) account for a large proportion of healthcare-associated infections, which means that surgery could be a risk factor for infection [15][16][17]. Surgical patients who are transferred to the ICU are more likely to have nosocomial infections than surgical patients in non-ICU wards [18].…”

Section: Discussionmentioning

confidence: 99%

Increased procalcitonin indicates antibiotic escalation in ICU patients: an observational study

Wang

Yun

et al. 2019

Preprint

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Background: Empirical antibiotic therapy often fails to cover all pathogens for patients with critical infection without pathogen identification. In these patients, progressive infection can manifest as a "procalcitonin (PCT) alert". Delayed proper antibiotic escalation could worsen their prognosis. We hypothesized that for these patients, escalating antibiotics after a "PCT alert" would improve their outcomes.Methods: This was a single-center retrospective study including patients with suspected infection who were admitted to Peking Union Medical College Hospital from January 2014 to June 2018. Patients were labelled as "antibiotic escalation" or "nonescalation" according to their antimicrobial use 48 h before and after the "PCT alert". "PCT alert" was defined as PCT ≥1.0 ng/mL that had not decreased by at least 10% from the previous day or from baseline, or a single measurement ≥ 1.0 ng/ml.Indicators that possibly influenced the prognosis were collected. 28-day intensive care unit (ICU)-free days were calculated; ICU stays >20 days and ≤20 days were considered nonprolonged ICU stays (nPISs) and prolonged ICU stays (PISs), respectively. Difference analysis and binary logistic regression were performed to determine the factors that influenced the 28-day ICU-free days .Results: A total of 1109 patients were included, 654 in the PIS group, other 455 in nPIS group. The PIS group had higher rates of pathogen identification (33.94% vs 28.13%, P=0.047) and escalated antibiotic therapy (35.47% vs 20.66%, P<0.001) but a lower proportion of surgical patients (39.45% vs 54.95%, P<0.001) than the nPIS group. Regarding PCT, the values on the 1st day (20.36±43.89 vs 14.89±30.37 ug/L, P=0.014) and on the "alert day" (24.24±46.38 vs 18.75±32.69 ug/L; P=0.021) were higher in the PIS group than nPIS group, but no significant difference in the white blood cell (WBC) count was revealed. According to the binary logistic regression model, antibiotic escalation (OR=0.552, 95% CI 0.347-0.877, P=0.012) was a negative factor for PIS, while postsurgical status (OR=1.959, 95% CI 1.269-3.023, P=0.002) and age (OR=1.020, 95% CI 1.007-1.034, P=0.003) were positive factors.Conclusions Escalating antibiotics in high-risk infection patients whose PCT does not decrease expectedly after administering broad-spectrum antimicrobials may reduce their ICU stay.3

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“…Sajini Souda Senior Lecturer, Department of Pathology, Faculty of Medicine, University of Botswana, discussed recent findings regarding the use of prophylactic antibiotics to prevent surgical site infections (SSIs) in PMH in Gaborone, the principal public hospital in Botswana. This prospective study involved 400 patients, with patients followed-up for 30 days post discharge to detect SSIs (21). The most common operations were exploratory laparotomy (25%), appendectomy (18.3%), excisions, and mastectomy (8%).…”

Section: Plenary Sessionmentioning

confidence: 99%

“…The most common antibiotics prescribed were cefotaxime (80.7%) and metronidazole (63.5%), with Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were the most common organisms identified. The incidence of SSI was 9%, and interventions have already been put in place to try and reduce this (21).…”

Section: Plenary Sessionmentioning

confidence: 99%

Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report

Tiroyakgosi

Matome

Summers³

et al. 2018

Expert Review of Anti-infective Therapy

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Prophylactic antibiotics to prevent surgical site infections in Botswana: findings and implications

Cited by 46 publications

References 34 publications

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

A multicenter point prevalence survey of antibiotic use in Punjab, Pakistan: findings and implications

Increased procalcitonin indicates antibiotic escalation in ICU patients: an observational study

Ongoing initiatives to improve the use of antibiotics in Botswana: University of Botswana symposium meeting report

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