Antibiotic use among surgical inpatients at a tertiary health facility: a case for a standardized protocol for presumptive antimicrobial therapy in the developing world
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Published on: August 30, 2018
U U Nnadozie1,2, C D Umeokonkwo3, C C Maduba1
1Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Nigeria.
Background:
Indiscriminate antimicrobial use is one of the greatest contributors to antimicrobial resistance. A low level of asepsis in hospitals and inadequate laboratory support have been adduced as reasons for indiscriminate use of antimicrobials among surgical patients. At present, there are no guidelines for presumptive antibiotic use in Nigeria and sub-Saharan Africa.
Aim:
Surgical inpatients at the study hospital were surveyed to determine the level of antimicrobial use and degree of compliance with prescription quality indicators.
Methods:
A cross-sectional survey was conducted among all surgical inpatients in May 2019 using a standardized tool developed by the University of Antwerp to assess the point prevalence of antimicrobials. Inpatients who were admitted from 08:00 h on the day of the survey were included. Data on patients' demographics, indication for antimicrobial use, reason for antimicrobial use, stop/review date, adherence to guidelines and laboratory use were collected. The prevalence of antimicrobial use in the surgical department was estimated.
Results:
Eighty-two inpatients were included in the survey. Of these, 97.6% were receiving at least one antimicrobial agent. Only 5.4% of the prescriptions were targeted, and 37.6% of prescriptions were for empirical treatment of infections. Approximately half (50.7%) of the patients were receiving presumptive antibiotics, and 6% were receiving prophylactic antibiotics. In total, 58.7% of prescriptions were administered parenterally, and 98.2% of patients had documentation of a stop/review date. Metronidazole (P=32.3%, T=29.2%), ceftriaxone (P=28.4%, T=19.8%) and ciprofloxacin (P=14.2%, T=14.6%) were the most common antimicrobials used.
Conclusions:
There is a high rate of antimicrobial use among surgical inpatients, and the rate of indiscriminate antimicrobial prescribing among these patients needs to be reduced. This can be achieved by developing antimicrobial guidelines for presumptive antimicrobial therapy.
Insights
Antimicrobial resistance is fueled by indiscriminate drug use. A study found 97.6% of surgical patients received antimicrobials, with most prescriptions not targeted, highlighting the need for new guidelines.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Public Health
Background:
- Indiscriminate antimicrobial use is a major driver of antimicrobial resistance.
- Poor hospital asepsis and limited laboratory support contribute to overuse in surgical patients.
- Nigeria and sub-Saharan Africa lack guidelines for presumptive antibiotic use.
Purpose of the Study:
- To assess the prevalence of antimicrobial use among surgical inpatients.
- To evaluate compliance with prescription quality indicators in a Nigerian hospital.
Main Methods:
- A cross-sectional survey of surgical inpatients was conducted in May 2019.
- A standardized tool assessed antimicrobial use, indications, stop dates, and laboratory support.
- Prevalence of antimicrobial use and prescription quality were estimated.
Main Results:
- 97.6% of 82 surgical inpatients received at least one antimicrobial.
- Only 5.4% of prescriptions were targeted; 50.7% were presumptive antibiotics.
- Metronidazole, ceftriaxone, and ciprofloxacin were the most common antimicrobials.
Conclusions:
- High rates of antimicrobial use and indiscriminate prescribing exist among surgical inpatients.
- Developing guidelines for presumptive antimicrobial therapy is crucial to reduce overuse.
- Addressing indiscriminate prescribing is essential to combat antimicrobial resistance.
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