Establishing an Antimicrobial Stewardship Program in Sierra Leone: A Report of the Experience of a Low-Income Country in West Africa

Abstract

Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone’s national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic.

High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study

“…As alluded to earlier, the inappropriate antibiotic use and the challenges of hand hygiene compliance and implementation reported in some facilities in Sierra Leone may underlie the spread of ESBL Enterobacteriaceae in our healthcare settings [ 15 , 16 , 32 – 34 ]. To address the long-term threats associated with the persistent burden of ESBL Enterobacteriaceae in our hospitals, we recommend the integration of surveillance of MRO to routine clinical care and strengthen IPC and AMS interventions [ 37 ].…”

Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021

“…The high use of postoperative SAP in the second study might be associated with the fact that surgeons and obstetricians were not trained on the WHO SAP guidelines as recommended by the first study. The intermittent supply of IPC commodities could have resulted in surgeons and obstetricians doubting the effectiveness of the IPC measures in the hospital to adequately prevent SSIs in their patients, as has been reported in a previous study [ 22 ]. However, according to De Jonge et al, postoperative SAP has no significant effect on reducing the incidence of SSIs [ 23 ].…”

Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report

“…Similarly, the high rates of use of levofloxacin in one of the hospitals may have contributed to resistance, which may potentially affect Sierra Leone’s national efforts to prevent and control multi-drug resistance tuberculosis [ 30 , 31 ]. Thus, the need to explore different stewardship interventions in our hospitals and different techniques to evaluate appropriate antibiotic prescribing practices [ 32 , 33 ].…”