Pattern of Peri-Operative Antibiotic Use among Surgical Patients in a Regional Referral and Teaching Hospital in Uganda

Abstract

Background: Prolonged surgical antimicrobial prophylaxis (SAP) to prevent surgical site infection (SSI) is generally discouraged after completion of surgery. However, little is known about the pattern of peri-operative antibiotic use in resource-limited settings. We aimed to describe its use at a typical government hospital in Uganda. Methods: A study was originally conducted in a rural Ugandan regional referral and teaching hospital in 2014 and 2015 to improve hand hygiene practice and measure its impact on health-care-associated infections including SSI (WardGel study). This is a secondary analysis of the data from the WardGel study to assess the frequency of peri-operative antibiotic use among surgical patients. Results: Of 3,627 patients enrolled into the original study, 960 (26.5%) underwent surgery at the hospital and 907 patients (94.5%) received antibiotic agents during hospitalization. Of these, 880 patients (97.0%, of 907 patients) received antibiotic agents on the day of surgery. A combination of ceftriaxone and metronidazole was the most common regimen (609/907 patients, 67.1%). Thirty-six of 907 patients (4.0%) started and completed their antibiotic agents on the day of surgery. The mean length of antibiotic use during hospitalization was 3.5 days (standard deviation, 3.3). After adjusting for covariates, linear regression analysis showed an extra 1.9 days of antibiotic use post-operatively (95% confidence interval = 1.7-2.3). During the total 4,960 inpatientdays for those having surgery, there were 6,503 days of therapy (DOTs) of antibiotic agents and 1,649 antibiotic-free days (AFDs). Conclusions: Most patients received prolonged antibiotic therapy after surgery. Antimicrobial stewardship for SAP can play a major role in combating antimicrobial resistance in resource-limited settings.

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

“…Recent efforts to measure antibiotic use in sub-Saharan African hospitals have been documented [ 19 , 20 , 21 , 22 ]. However, there are limited studies that utilize the standardized WHO PPS methodology for resource-limited settings, such as Ugandan hospitals [ 23 , 24 , 25 ]. This paper presents data from 13 hospitals in the context of a global health security agenda project for strengthening antimicrobial stewardship programs in low- and middle-income countries.…”

Access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda: a qualitative study

“…The NAP emphasizes the need to strengthen the evidence base on antimicrobial use to inform policy including through research [ 9 ]. However, most of the research on AMS in the country to date has been from large health facilities [ 27 – 29 ], with minimal literature from community settings. Given that AMR is a complex public health problem that concerns many sectors, there is need for more evidence on access and use of antimicrobials among humans and animals particularly in the community, as well as disposal of antimicrobials at household level.…”

Antibiotics Using Pattern in Surgery Department of a Maternity and Children Hospital

“…Furthermore, Maheshwari et al reported that regarding prescribing patterns of antibiotics in post-operative patients of surgery department, most common antimicrobial administered was cephalosporin's (40%) [20]. Saito et al stated that the most common prescribed antibiotic agents during hospitalization were a combination of ceftriaxone and metronidazole, followed by a single regimen of ceftriaxone [21]. They also reported that regarding pattern of peri-operative antibiotic use among surgical patients in a regional referral and teaching hospital in Uganda, the combination of ceftriaxone and metronidazole was more common in the obstetrics and gynecology department whereas other combination regimens were more common in the surgical department [21].…”