Patterns of Antimicrobial Use in a Specialized Surgical Hospital in Southeast Nigeria

Abstract

Background: Antimicrobial resistance remains a growing global health menace. One of the key actions to curb this menace by the World Health Organization is antimicrobial stewardship (AMS). A prescription protocol is one of the cost-effective AMS interventions in surgery. This study determines the patterns of antimicrobial usage in a hospital specialized in orthopedic and plastic surgeries care in Nigeria. Methods: A cross-sectional survey was carried out at National Orthopaedic Hospital Enugu, a tertiary hospital specialized in orthopedic and plastic surgeries in Southeast Nigeria in May 2019. All the inpatients were included in the study. A standardized tool for point prevalence survey was used to collect data. Data were analyzed using Epi Info version 7.2.4. Results: A total of 127 inpatients participated in the survey with 387 antimicrobial encounters. The most common reasons for antimicrobial use were for the treatment of community-acquired infections (65.0%) and prophylaxis (29.4%). The decision for their use was made majorly on an empirical basis (92.4%). The reasons for antimicrobial prescriptions were documented in the majority (97.5%) of the cases and stop review dates in all (100%) of the prescriptions. Ceftriaxone (25.7%), tinidazole (21.9%), and metronidazole (14.6%) were the commonest antimicrobials prescribed among the patients. Conclusion: Orthopedic and plastic surgery practices require tailored prophylactic antibiotic regimens in the tropics due to peculiarities of both the specialties and the subregion. The claim that existing protocols in the temperate regions may apply in the tropics has been questioned due to the microbial profile on the tropics.

Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies

“…Overall, the prevalence of antibiotic use among hospitalized patients in Africa ranged from 27.6 to 83.5% [ 28 , 39 ]. The prevalence of antibiotic use was higher in West Africa (ranged from 51.4 to 83.5%) [ 19 , 21 , 22 , 25 – 27 , 29 , 33 , 35 – 37 , 39 – 41 , 47 , 48 ], followed by North Africa (79.1%) [ 20 ], East Africa (ranged from 27.6 to 73.7%) [ 28 , 30 – 32 , 34 , 38 , 42 – 44 ], and South Africa (ranged from 33.6 to 49.7%) [ 45 , 46 ]. The highest prevalence of antibiotic use was found in Nigeria (83.5%) [ 39 ], Ghana (82%) [ 25 ], Egypt (79.1%) [ 20 ], and Uganda (73.7%) [ 34 ].…”

“…The prevalence of antibiotic use was higher in West Africa (ranged from 51.4 to 83.5%) [ 19 , 21 , 22 , 25 – 27 , 29 , 33 , 35 – 37 , 39 – 41 , 47 , 48 ], followed by North Africa (79.1%) [ 20 ], East Africa (ranged from 27.6 to 73.7%) [ 28 , 30 – 32 , 34 , 38 , 42 – 44 ], and South Africa (ranged from 33.6 to 49.7%) [ 45 , 46 ]. The highest prevalence of antibiotic use was found in Nigeria (83.5%) [ 39 ], Ghana (82%) [ 25 ], Egypt (79.1%) [ 20 ], and Uganda (73.7%) [ 34 ]. The lowest rate of antibiotic use was observed in Malawi (27.6%) [ 28 ], followed by South Africa (33.6%) [ 45 ] and Tanzania (44.0%) [ 31 ].…”

“…Both oral and parenteral antibiotics are used among hospitalized patients in Africa. The parenteral antibiotics were the most commonly used and accounted for 54.0–98.6% of all antibiotics ( n = 18 studies) [ 19 – 22 , 30 , 32 – 37 , 39 , 41 , 42 , 45 – 48 ] while oral antibiotics accounted for 11.0–46.0% ( n = 11 studies) [ 19 , 21 , 22 , 32 , 34 , 37 , 39 , 42 , 45 – 47 ].…”

“…A total of 15 studies reported top five most commonly prescribed antibiotics in inpatient settings in Africa. Based on the results, ceftriaxone ( n = 14 studies) and metronidazole ( n = 12 studies) were the most commonly used antibiotics, and the rates ranged from 7.4 to 51.7% [ 19 , 21 , 22 , 27 , 28 , 31 , 33 – 36 , 38 , 39 , 41 , 44 , 46 ] and 14.6 to 44.8% [ 19 , 21 , 22 , 28 , 31 , 33 – 36 , 38 , 39 , 41 , 44 ], respectively. This was followed by gentamicin ( n = 8 studies; range: 6.6–22.3%) [ 19 , 21 , 22 , 27 , 31 , 33 , 34 , 38 , 44 , 46 ], ampicillin ( n = 6 studies; range: 6.0–29.2%) [ 27 , 29 , 31 , 34 , 44 , 46 ], cefuroxime ( n = 6 studies; range: 5.4–18.4%) [ 21 , 27 , 35 , 36 , 39 , 41 ], ciprofloxacin ( n = 6 studies; range: 7.8–17.4%) [ 21 , 22 , 27 , 28 , 33 , 36 ], and amoxicillin-clavulanate ( n = 6 studies; range: 8.8–13.4%) [ 22 , 33 , 35 , 36 , 41 , 46 ].…”

“…The documentation of dates for stop/review ranged from 19.6 to 100% ( n = 5 studies) [ 20 , 33 , 36 , 39 , 40 ] while taking specimen for microbiology culture ranged between 2.7 and 25% ( n = 3 studies) [ 19 , 20 , 27 ]. The quality of antibiotic prescribing varied with the prevalence of prolonged surgical antimicrobial prophylaxis (administration for more than 24 h) ranging from 66.7 to 100% ( n = 14 studies) [ 19 – 22 , 30 , 31 , 33 , 34 , 36 , 39 – 41 , 45 , 46 ]. One study reported that 6.2% of hospitalized patients with two or more antibiotics had redundant antibiotic prescriptions [ 22 ].…”