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High levels of surgical antibiotic prophylaxis: Implications for hospital-based antibiotic stewardship in Sierra Leone
- Sulaiman Lakoh, Joseph Sam Kanu, Sarah K. Conteh, James B.W. Russell, Stephen Sevalie, Christine Ellen Elleanor Williams, Umu Barrie, Aminata Kadie Kabia, Fatmata Conteh, Mohamed Boie Jalloh, Gibrilla F. Deen, Mustapha S. Kabba, Aiah Lebbie, Ibrahim Franklyn Kamara, Bobson Derrick Fofanah, Anna Maruta, Christiana Kallon, Foday Sahr, Mohamed Samai, Olukemi Adekanmbi, Le Yi, Xuejun Guo, Rugiatu Z. Kamara, Darlinda F. Jiba, Joseph Chukwudi Okeibunor, George A. Yendewa, Emmanuel Firima
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue 1 / 2022
- Published online by Cambridge University Press:
- 07 July 2022, e111
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Objective:
Despite the impact of inappropriate prescribing on antibiotic resistance, data on surgical antibiotic prophylaxis in sub-Saharan Africa are limited. In this study, we evaluated antibiotic use and consumption in surgical prophylaxis in 4 hospitals located in 2 geographic regions of Sierra Leone.
Methods:We used a prospective cohort design to collect data from surgical patients aged 18 years or older between February and October 2021. Data were analyzed using Stata version 16 software.
Results:Of the 753 surgical patients, 439 (58.3%) were females, and 723 (96%) had received at least 1 dose of antibiotics. Only 410 (54.4%) patients had indications for surgical antibiotic prophylaxis consistent with local guidelines. Factors associated with preoperative antibiotic prophylaxis were the type of surgery, wound class, and consistency of surgical antibiotic prophylaxis with local guidelines. Postoperatively, type of surgery, wound class, and consistency of antibiotic use with local guidelines were important factors associated with antibiotic use. Of the 2,482 doses administered, 1,410 (56.8%) were given postoperatively. Preoperative and intraoperative antibiotic use was reported in 645 (26%) and 427 (17.2%) cases, respectively. The most commonly used antibiotic was ceftriaxone 949 (38.2%) with a consumption of 41.6 defined daily doses (DDD) per 100 bed days. Overall, antibiotic consumption was 117.9 DDD per 100 bed days. The Access antibiotics had 72.7 DDD per 100 bed days (61.7%).
Conclusions:We report a high rate of antibiotic consumption for surgical prophylaxis, most of which was not based on local guidelines. To address this growing threat, urgent action is needed to reduce irrational antibiotic prescribing for surgical prophylaxis.
Road to Increasing AMR: A Study on Antibiotics Prescribing Pattern
- Bobson Derrick Fofanah, Christiana Conteh, Jamine Weiss
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s496-s497
- Print publication:
- October 2020
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Background: Infectious diseases and the rapid emergence of multidrug-resistant pathogens continue to pose a threat to global health. The development of antimicrobial-resistant organisms is an alarming issue caused by inappropriate use of antibiotic agents. It is estimated that death from antimicrobial resistant pathogens could increase >10-fold to ~10 million deaths annually by 2050 if action is not taken. “It is essential to have reliable data on how medicines are used in order to identify areas to develop targeted interventions” (WHO 2011). Investigating antimicrobial use in hospitals is the first step in evaluating the underlying causes of AMR. In Sierra Leone, no other study related to antibiotic prescribing patterns in hospital setting has been undertaken. Objective: To investigate antibiotic prescription patterns using the WHO hospital antimicrobial use indicator tool at the Kingharman Hospital for 1 month. Methods: Data were collected from patient charts for 1 month, January 1–31, 2019. A data extraction tool was used to capture information on patient demographics, diagnosis, and antibiotics prescription details regarding dosage, duration, and frequency of administration. The tool adopted 6 selected indicators from the WHO antimicrobial use manual to measure the extent of antibiotic use in hospital and performance among prescribers. Results: Of the 189 charts reviewed, 175 included antibiotic prescriptions. The percentage of prescriptions involving antibiotics was 92.5%. The average number of drugs prescribed was 2, with an average duration of 5.2 days. Moreover, 50.5% of antibiotics prescribed were generic, and 96.6% were from the Ministry of Health and Sanitation Essential Medicine List (EML). The most commonly used antibiotics were ciprofloxacin (38.8%), followed by ceftriaxone (23.0%), amoxicillin (16.8%), metronidazole (8.5%), and others(12.7%). Typhoid accounted for 34.8% of broad-spectrum antibiotics, UTI accounted for 17.7%, malaria accounted for 12.5%, 25.5% were unspecified, and 9.5% were for unclear diagnoses. Typically, combinations of fluroquinolones and cephalosporins were used to treat typhoid and UTIs. Conclusions: This cross-sectional study represents a broad picture of antibiotic prescribing patterns at the King Harman Hospital. There was no strict adherence to the WHO recommended prescribing guidelines. These findings also indicate the degree of irrational and inappropriate prescribing of broad-spectrum antibiotics. This study highlights the need for a comprehensive assessment of antimicrobial use to gain a better understanding of national antibiotic use and to guide interventions to reducing AMR.
Funding: None
Disclosures: None
If I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.
Disagree
Christiana Kallon
Patient Involvement in Infection Prevention and Control (IPC) Practice: Knowledge and Perception Study
- Bobson Derrick Fofanah, Christiana Conteh
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s493
- Print publication:
- October 2020
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Background: Patient involvement is increasingly recognized as critical component for improved care, and patients has been identified of as having a potentially important role for better health outcome as a result of their involvement in their care plan. A usual saying that infection prevention and control is “everyone’s business” is frequently understood to include not only healthcare workers but also patients and their relatives, all of whom are seen as stakeholders with a part to play in ensuring a better patient outcome. There is limited evidence about knowledge and perception about involving patient and/or relatives in IPC implementation in a post–Ebola-outbreak country. Objectives: We aimed to ascertain the knowledge and perception of patient involvement in infection prevention and control (IPC) practice. Methods: We used a qualitative approach comprising interviews with patients and/or relatives and health workers sampled from 5 hospitals. Participants (n = 60) included 25 nurses, 25 patients and/or relatives, 5 IPC focal persons, and 5 hospital administrators. Interviews used a structured questionnaire to explore staff views on patient involvement. A separate questionnaire was used to survey patient perspectives and knowledge about basic hospital IPC practices. Results: Of 60 interviews, 64% of nurses supported involving patient in hospital IPC practice, saying that the patient can serve as a reminder during the time of care, whereas 36% disagreed with involving the patient because of fear of having confrontations with the patient. Also, 92% of patients and/or relatives agreed to their involvement because they viewed it as their right; only 8% did not accept involvement because they thought it was a burden and not their responsibility. All 5 IPC focal persons (100%) supported patient involvement; they thought it would enhance overall IPC compliance and keep healthcare workers reminded of IPC practice, most especially hand hygiene. Also, 100% of hospital administrators supported involving patients because they felt that patient should be involved in their care plan. Conclusions: From this study, it is evident that patient involvement is key in optimizing IPC compliance in hospitals. The study findings indicate that most patients have knowledge of the importance of hand washing since the Ebola outbreak; however, they lack knowledge on other practices such as waste disposal, cough etiquette, etc. There is need for IPC orientation on admission and continuous patient education.
Funding: None
Disclosures: None
If I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.
Disagree
Christiana Kallon