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 (original) (raw)
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Advances in Pharmacoepidemiology and Drug Safety, 2017
Background: Antibiotic are among the most prescribed drug in medical ward. Because of the rise in health care cost lack of uniformity in drug prescribing and the emergency of antibiotic resistance monitoring and control of antibiotic use are growing concern and strict antibiotic policies should be warranted. Inappropriate use of antibiotic can increase morbidity, mortality, patient cost and bacterial antibiotic resistance.
Inappropriate antibiotic use results emergence of resistance, preventable morbidity and mortality and resource wastage. Institution based retrospective cross sectional study was conducted using patient cards and prescription registration books to assess antibiotics utilization pattern in adult medical wards of Finote Selam Hospital (FSH). 30 cases per quarter were selected from the documented cards, based on Joint Commission on Accreditation of Health Organizations (JCAHO) sample size recommendation. Out of 130 cards reviewed, ceftriaxone (31.02%), amoxicillin (14.29%) and gentamicin (13.88%) were commonly prescribed. Combined antibiotics were used in 17.50% of cases and 18.77% of prescribed antibiotics were inappropriately indicated. 53.88% of prescribed antibiotics were administered through the intravenous route. Average number of antibiotics per encounter was 1.22 and 97.1% of antibiotics were prescribed with generic name. 58% of antibiotics were prescribed from Essential Drug List (EDL). Correct frequency and duration were specified in 88.16% and 42.04% of the antibiotics respectively. Duration, dosage form, route and frequency were not specified in 57.96%, 10.20%, 8.57% and 6.53% of antibiotics respectively. Not specifying dosage form, route, and duration; prescription habit deviating from EDL and improper indication were problems identified. Good generic prescription habit, low level poly-pharmacy and specifying frequency were the good practices observed.
Infection and Drug Resistance
Background: Ethiopia is one of the countries where the healthcare system is not yet developed to the required level; hence, it is not uncommon that drugs, particularly antimicrobials, are inappropriately used for infections by any causative agents, with or without prescription, in combination or not, and, of more concern, without sensitivity tests. So, it was considered important to assess the magnitude of inappropriate antimicrobial use among inpatients attending Madda Walabu University Goba Referral Hospital, southeast Ethiopia. Methods: A health institution-based cross-sectional study was conducted from September 2018 to April 2019. Patient folders from collaborating wards were reviewed for antibiotic use. Inappropriateness of a drug or its dosage, or both, was considered in reference to the Ethiopian national treatment guideline. The information obtained was analyzed using SPSS version 20. Patterns of prescription of antimicrobials for the hospitalized patients were analyzed using simple descriptive statistics. Results: A total of 801 antibiotics were written as prescriptions to 471 clients, 228 (47.6%) of whom had received two or more antibiotics at the time of the study. Of the total prescribed antibiotics, 142 (30.1%) had an inappropriate prescription. Genitourinary tract infections accounted for 42 (30.4%) of the inappropriate prescriptions due to the wrong dose and drugs. Cephalosporins were the most extensively prescribed class of antibiotics, 24.4% of which were inappropriately prescribed. Intravenous formulations made up the largest proportion of prescriptions, at 335 (41.8%). The most commonly prescribed antimicrobials were cephalosporins, 178 (38%); nitroimidazoles, 115 (24.5%); and macrolides, 53 (11.3%), while ceftriaxone was prescribed in 249 (53%) and metronidazole in 123 (26.2%) cases. Conclusion: Low dose, inadequate duration and empiric use of antibiotics were major causes of inappropriate use in the study area. Therefore, local antimicrobial sensitivity tests, antibiotic stewardship and following the national treatment guideline are recommended to overcome inappropriate antimicrobial use.
BMJ Open, 2022
ObjectiveEffective antimicrobial containment strategies such as Antimicrobial Stewardship Programs (ASPs) require comprehensive data on antibiotics use which are scarce in Ethiopia. This study sought to assess antibiotics use and healthcare-associated infections (HCAIs) in Ethiopian public hospitals.DesignWe conducted a cross-sectional study using the WHO point-prevalence survey protocol for systemic antibiotics use and HCAIs for low/middle-income countries.SettingThe study was conducted among 10 public hospitals in 2021.ParticipantsAll patients admitted to adult and paediatric inpatient and emergency wards before or at 08:00 on the survey date were enrolled.Outcome measureThe primary outcome measures were the prevalence of antibiotic use, HCAIs and the hospitals’ readiness to implement ASP.ResultsData were collected from 1820 patient records. None of the surveyed hospitals had functional ASP. The common indication for antibiotics was for HCAIs (40.3%). Pneumonia was the most common...
Antibiotics Utilization and their Cost in Ayder Referral Hospital, Mekelle, Ethiopia
Inappropriate use of antibiotics can potentially lead to antimicrobial resistance and increase the necessity to use more expensive antibiotics to treat common and life threatening infections. The major goal of this research was to determine antibiotics utilization and their cost among in-patients treated in Ayder Referral Hospital. An institution based cross-sectional study was conducted in medical, gynecology and obstetrics, and surgical wards from September to December, 2012. The prevalence of antibiotics use was 35.5%. Antibiotic therapy was found to be inappropriate in 137 patients (80.6%). Keywords: irrational drug use, antibiotics, ayder referral hospital, cost, inpatients.
BioMed Research International
Background. Surgical site infections are the third (14%-16%) most frequent cause of nosocomial infections among hospitalized patients. They still form a large health problem and result in increased antibiotic usage, increased associated costs, and prolonged hospitalization and contribute to increased patient morbidity and mortality. Therefore, studies on surgical site infections and surgical antibiotic prophylaxis contribute to identifying surgical site infection rate and risk factor associated with it as well as for identifying the gap in surgical antibiotic prophylaxis practice. Objective. To assess surgical antibiotic prophylaxis practice and surgical site infection among surgical patients. Method. A hospital-based prospective observational study was conducted in 68 patients who underwent major surgery in Dessie Referral Hospital adult surgical wards between March 24 and April 25/2017. Descriptive and logistic regression analyses were performed to determine infection rate and ris...
Paediatric antibiotic prescription is a major concern in terms of public health, since infections are the most frequent cause of childhood disease. The aim of this a hospital-based cross sectional study was to assess the pattern of antibiotic use in the Paediatric ward of Hawassa University referral hospital, southern-Ethiopia. Data was entered into a computer and statistical analysis was done using SPSS for windows version16. From the result of the study, the frequency and percentage of antibiotic prescriptions identified was 1381 (74.7%); (Wald test, p < 0.01), and the frequency and percentage of Injectable prescription was 1729 (93.6%); (Wald test, p < 0.01). The mean number of drugs prescribed per-prescription was 1.58±0.743. The mean of antibiotics prescriptions in preschool children was relatively higher (1.26; 95% C.I b/n 1.03-1.29) compared to other pediatric age groups. The use of antibiotic by pediatric age category was found to be significant (Pearson Chi-Square P= 0.037). Very strong positive correlation of antibiotic use was observed with generics prescriptions and injection prescriptions (0.740 and 0.731 with p-value < 0.01) respectively. The potential Drug-Drug Interactions (DDIs) identified in the study area was 66% (Fisher's Exact Test, P< 0.01). The availability of a set of key antimicrobial drugs in the hospital stores on the day of the study was 90.1%. The most frequently prescribed single antibiotic was penicillin G crystalline 146 (28.4%), While the most commonly prescribed multiple antibiotic prescriptions was 'Ampicillin inj plus Gentamicin inj' 113 (27%) followed by 'Chloramphenicol inj plus Cloxacillin inj' 60 (14.4%). From the result we can conclude that, there was a significant oral and injectable antibiotic utilization in the study area compared to similar studies conducted in other part of the world.
Infection and Drug Resistance, 2020
Background: Irrational prescribing of antibiotics is a universal public health problem, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is crucial to tackling irrational prescription. Yet, comprehensive studies regarding the prescribing pattern of antibiotics among inpatients and the need for an Antibiotic Stewardship Program (ASP) are lacking in Ethiopia. This study aimed to evaluate prescribing patterns of antibiotics and the need for an ASP. Methods: A hospital-based prospective observational study was carried out from February 2019 to December 2019. This study was conducted among patients admitted to Aksum University Comprehensive Specialized Hospital, Ethiopia. Data were collected using a data abstraction format generated by World Health Organization (WHO) prescribing indicators. Data analysis was carried out using SPSS version 25.0. Results: A total of 1653 antibiotics were prescribed for 822 inpatients. Overall, 52.3% of patients had at least one oral and/or injectable antibiotic prescribed, for a mean duration of 4.2 (SD=2.3) days. The average number of prescribed antibiotics per patient was 2.01 (SD=1.9). The majority (97.6%) of antibiotics were prescribed by their generic name, and all prescribed antibiotics were from the national Essential Medicine List (EML). Frequently prescribed injectable and oral antibiotics were ceftriaxone (24.5%) and azithromycin (12.9%), respectively. Culture and sensitivity testing were not performed in any of the cases. During the study period, 65.2% of key antibiotics were available in stock. Conclusion: In this study, more than half of patients were on at least one antibiotic, and all antibiotics were prescribed from the national EML. However, all antibiotics were prescribed empirically. This result shows that the prescribing pattern of antibiotics in the hospital deviates from and is non-compliant with the standard endorsed by WHO. This study provides evidence for the necessity and a way forward for the establishment of an ASP in the hospital that may help to introduce the prescribing of antibiotics with the aid of culture and sensitivity tests, and to develop institutional guidelines.
2018
Results: Females accounted for about 55% of the total 193 study participants whose mean (± SD) age was 39.97 ± 17.12. More than half (58.6%) of the participants had presumed systemic bacterial infections on admission. Whilst pneumonia was the first most prevalent infection presumed (47.7%), cephalosporins were the most widely prescribed (66.7%) class of drugs. Only one culture and 8 gram stain reports were documented and all the drugs were empirically used. About 8% of the wards patients were died during the in-hospital stay. The mean (± SD) inhospital length of stay was 6.98 ± 3.22 days (range: 3-18). While presence of a medical device was a positive predictor (AOR=4.50, 95% CI: 1.09, 18.60, p=0.038) and prolonged length of stay was the negative predictor (AOR=0.22, 95% CI: 0.05, 0.90, p=0.035) of mortality. On the other hand only presence of multidrug resistance (MDR) risk (AOR=6.14, 95% CI: 1.68, 22.41, p=0.006) was positively associated with prolonged in-hospital length of stay. Conclusion: Generally, these observations showed that all patients with systemic bacterial infection received antibiotics on an empiric basis. Broad spectrum third generation cepalosporins were the most commonly used drugs. These warrant an appropriate antimicrobial use policy in the context of resource-limited settings.
Infection and Drug Resistance
Objective: Surgical site infection (SSI) is one of the leading causes of hospital-acquired infection among hospitalized patients. It causes significant health problems and results in an extended length of hospital stay, increased cost, and increased patient morbidity and mortality. To prevent the development of SSI, surgical antibiotic prophylaxis (SAP) administration before surgery is an evidence-based practice. Therefore, this study aimed to assess the prevalence of SSIs and surgical antibiotic prophylaxis practice, and identifying the gap in practicing prophylactic surgical antibiotic use. Methods: A retrospective cross-sectional study design was conducted on randomly selected 281 participants who fulfilled the inclusion criteria. Appropriateness of surgical antibiotic prophylaxis was assessed by clinical pharmacists based on the standard treatment guideline. Descriptive and multivariate logistic regression analyses were performed in SPSS version 25. Statistical significance was set at p <0.05. Results: The overall prevalence of SSI was 19.6% (95% CI: 19-20.2). Majority of surgical patients (88.6%) got surgical antibiotic prophylaxis. Ceftriaxone and metronidazole (45.4%), and ceftriaxone (33.3%) were the most frequently used prophylactic antibiotics. Presence of comorbidity (AOR=9.18, 95% CI: 5.17-17.9, p<0.001), contaminated (AOR=6.01, 95% CI: 1.77-16.8, p=0.019) and dirty (AOR=7.20, 95% CI: 1.23-12.1, p=0.029) wound classes, devoid of prophylactic antibiotics (AOR=6.63, 95% CI: 0.89-19.3, p=0.006), the timing of prophylactic antibiotic administration between 1 hour and 2 hours before incision (AOR=8.2, 95% CI: 4.34-18.1, p=0.001), and 48 hours duration of surgical antimicrobial prophylaxis (AOR=7.20, 95% CI: 1.23-28.17, p=0.027) were significantly associated with the development of SSIs. Conclusion: The prevalence of SSI was relatively high despite most surgical patients were given prophylactic antibiotics. The presence of comorbidity, contaminated and dirty wound classes, devoid of prophylactic antibiotics, administering prophylactic antibiotics between 1 hour and 2 hours before incision, and 48 hours duration of surgical antibiotic prophylaxis were significantly associated with SSIs.