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

BMC Infectious Diseases

Research

Joseph Sam Kanu¹  James B.W. Russell¹  Christine Ellen Elleanor Williams¹  Gibrilla F. Deen¹  Sulaiman Lakoh²  Stephen Sevalie³  George A. Yendewa⁴  Emmanuel Firima⁵  Olukemi Adekanmbi⁶  Umu Barrie⁷  Daniel Sesay⁸  Sarah K. Conteh⁸  Darlinda F. Jiba⁸  Anna Maruta⁹  Joseph Chukwudi Okeibunor^1,10 

[1] College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone;Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone;College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone;Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone;Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone;Infectious Disease Research Network, Freetown, Sierra Leone;College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone;Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone;34 Military Hospital, Freetown, Sierra Leone;Department of Medicine, Case Western Reserve University School of Medicine, Ohio, USA;Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;SolidarMed, Maseru, Lesotho;Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria;Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria;Department of Medicine, University College Hospital, Ibadan, Nigeria;Infectious Disease Research Network, Freetown, Sierra Leone;Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone;World Health Organization Country Office, Freetown, Sierra Leone;World Health Organization Regional Office for Africa, Brazzaville, Congo;

关键词: Defined daily dose (DDD);    ACCESS, WATCH and RESERVE (AWaRe);    Antibiotic consumption;    Sierra Leone;    Antimicrobial resistance (AMR);   

DOI  :  10.1186/s12879-023-08517-0

 received in 2022-08-18, accepted in 2023-08-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAlthough one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone.MethodsThis is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16.ResultsThe mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days).ConclusionAntibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 5