Background: Antimicrobial
resistance (AMR) is one of the top 10 global public health threats facing
humanity and this burden is borne largely by low and middle-income countries.
As part of efforts to combat AMR, the World Health Organization has identified
Antimicrobial Stewardship as one of the strategic objectives of its global
action plan on antimicrobial resistance. This survey aimed to observe
antimicrobial prescribing and usage patterns in the Rivers State University
Teaching Hospital with the purpose of identifying gaps to inform the specific
antimicrobial stewardship interventions necessary to address our specific
needs. Methodology: A point prevalence survey was conducted using the
protocol and web-based automated data management system designed by the Global
Point Prevalence Survey of Antimicrobial Consumption and Resistance, University
of Antwerp, Belgium, in November 2021. Results: A total of 69 adult
medical and surgical patients were surveyed; 27 males and 18 females.
Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;
33.3%), fluoroquinolones (17.8%; 22.2%) and imidazole derivatives (20%; 36.1%)
were most prescribed on the medical and surgical wards. Antimicrobial
guidelines were completely unavailable, most antimicrobials (93.8%) were
prescribed empirically and 64.4% of these remained empirical after 72 hours of
commencement. Conclusion: Antimicrobial stewardship interventions are
necessary to minimize sub-optimal antimicrobial prescribing practices in our
facility. Most critical are education on appropriate use of antimicrobials,
support for development of antimicrobial guidelines, diagnostic stewardship,
and the drive for improved use of the laboratory to guide antimicrobial
prescriptions. The antimicrobial stewardship committee and team must drive
this, having the requisite support from the management and prescribers, with
the primary outcomes being reduced antimicrobial prevalence and improved
antimicrobial prescription patterns.
References
[1]
Antimicrobial Resistance (2022) World Health Organization Fact Sheets. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
[2]
Pollack, L.A. and Srinivasan, A. (2014) Core Elements of Hospital Antibiotic Stewardship Programs from the Centers for Disease Control and Prevention. Clinical Infectious Diseases, 59, S97-S100. https://doi.org/10.1093/cid/ciu542
[3]
Murray, C.J., Ikuta, K.S., Sharara, F., Swetschinski, L., Aguilar, G.R., Gray, A., Han, C., Bisignano, C., Rao, P., Wool, E. and Johnson, S.C. (2022) Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. The Lancet, 399, 629-655. https://doi.org/10.1016/S0140-6736(21)02724-0
[4]
World Health Organization (2016) Global Action Plan on Antimicrobial Resistance. https://www.who.int/publications/i/item/9789241509763
[5]
Kpokiri, E.E., Taylor, D.G. and Smith, F.J. (2020) Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals. Antibiotics, 9, Article No. 204. https://doi.org/10.3390/antibiotics9040204
[6]
Fishman, N. (2012) Policy Statement on Antimicrobial Stewardship. Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infection Control & Hospital Epidemiology, 33, 322-327. https://doi.org/10.1086/665010
[7]
Wood, C.E., Luedtke, S., Musah, A., Bammeke, F., Mutiu, B., Ojewola, R., Bankole, O., Ademuyiwa, A.O., Ekumankama, C.B., Ogunsola, F. and Okonji, P. (2022) Exploring Barriers to Guideline Implementation for Prescription of Surgical Antibiotic Prophylaxis in Nigeria. JAC-Antimicrobial Resistance, 4, dlac044. https://doi.org/10.1093/jacamr/dlac044
[8]
Ayukekbong, J.A., Ntemgwa, M. and Atabe, A.N. (2017) The Threat of Antimicrobial Resistance in Developing Countries: Causes and Control Strategies. Antimicrobial Resistance & Infection Control, 6, 1-8. https://doi.org/10.1186/s13756-017-0208-x
[9]
Saleh, N., Awada, S., Awwad, R., Jibai, S., Arfoul, C., Zaiter, L., Dib, W. and Salameh, P. (2015) Evaluation of Antibiotic Prescription in the Lebanese Community: A Pilot Study. Infection Ecology & Epidemiology, 5, 27094. https://doi.org/10.3402/iee.v5.27094
[10]
Otaigbe, I.I. and Elikwu, C.J. (2023) Drivers of Inappropriate Antibiotic Use in Low- and Middle-Income Countries. JAC-Antimicrobial Resistance, 5, dlad062. https://doi.org/10.1093/jacamr/dlad062
[11]
Ola-Bello, O.I., Akintan, P.E., Osuagwu, C.S., Oshun, P.O., Fajolu, I.B., Nwaiwu, O., Olusanya, A., Busari, A.A., Roberts, A.A., Temiye, E.O. and Omotayo, O. (2023) “Prospective Audit with Intervention and Feedback” as a Core Antimicrobial Stewardship Strategy in the Paediatrics Department of a Nigerian Tertiary Hospital. Nigerian Postgraduate Medical Journal, 30, 137-143. https://doi.org/10.4103/npmj.npmj_257_22
[12]
Chukwu, E.E., Oshun, P.O., Osuolale, K.A., Chuka-Ebene, V.O., Salako, A., Idigbe, I.E., Oladele, D., Audu, R.A. and Ogunsola, F.T. (2021) Antimicrobial Stewardship Programmes in Healthcare Facilities in Lagos State, Nigeria: A Needs Assessment. Journal of Global Antimicrobial Resistance, 25, 162-170. https://doi.org/10.1016/j.jgar.2021.02.034
[13]
Okechukwu, R., Eli-Ilo, J., Onyejiaka, C., Ebenebe, J., Egbuniwe, M., Obasikene, C., Chisom, N.E. and Ugboaja, J. (2019) 53 Survey of Perception, Attitudes and Practices of Antimicrobial Stewardship among Health Workers in a Nigerian University Teaching Hospital. https://doi.org/10.1136/bmjebm-2019-EBMLive.61
[14]
Iregbu, K.C., Nwajiobi-Princewill, P.I., Medugu, N., Umeokonkwo, C.D., Uwaezuoke, N.S., Peter, Y.J., Nwafia, I.N., Elikwu, C., Shettima, S.A., Suleiman, M.R. and Awopeju, A.T.O. (2021) Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges. African Journal of Clinical and Experimental Microbiology, 22, 60-66. https://doi.org/10.4314/ajcem.v22i1.8
[15]
Abubakar, U. (2020) Antibiotic Use among Hospitalized Patients in Northern Nigeria: A Multicenter Point-Prevalence Survey. BMC Infectious Diseases, 20, Article No. 86. https://doi.org/10.1186/s12879-020-4815-4
[16]
Awopeju, A.T.O., Robinson, N.I., Ossai-Chidi, L.N., Jonah, A.A., Alex-Wele, M.A., Oboro, I.L., Okoli, C.D., Duru, C.C., Ugwu, R., Yago-Ide, L.E. and Paul, N.I. (2023) Point Prevalence Survey of Antimicrobial Prescription and Indicators in a Tertiary Healthcare Center in Southern Nigeria. South Asian Journal of Research in Microbiology, 15, 1-9. https://doi.org/10.9734/sajrm/2023/v15i3286
[17]
Iregbu, K.C., Osuagwu, C.S., Umeokonkwo, C.D., Fowotade, A.A., Ola-Bello, O.I., Nwajiobi-Princewill, P.I., Taiwo, S.S., Olayinka, A.T. and Oduyebo, O.O. (2020) Underutilization of the Clinical Microbiology Laboratory by Physicians in Nigeria. African Journal of Clinical and Experimental Microbiology, 21, 53-59. https://doi.org/10.4314/ajcem.v21i1.7
[18]
Mesfin, E.A., Taye, B., Belay, G., Ashenafi, A. and Girma, V. (2017) Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia. EJIFCC, 28, 205-223.
[19]
Ijah, R.F.O.A., Onodingene, N.M., Iroegbu-Emeruem, L.U., Aaron, F.E., Ogamba, M., Maduka, A.D. and Oboro, I. (2023) Diagnostic Support for the Surgical Patient: The Experiences and Challenges, as Seen by Practitioners in Resource-Poor Setting. Journal of Surgical Research, 5, 1-8. https://doi.org/10.33425/2689-1093.1053
[20]
Centers for Disease Control and Prevention (2018) The Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings: National and Hospital Levels. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/stewardship-resource-limited-508.pdf
[21]
Oshun, P.O., Roberts, A.A., Osuagwu, C.S., Akintan, P.E., Fajolu, I.B., Ola-Bello, O.I., Odukoya, O.O., Akodu, B., Okunowo, A.A., Versporten, A. and Pauwels, I. (2021) Roll out of a Successful Antimicrobial Stewardship Programme in Lagos University Teaching Hospital Nigeria Using the Global-Point Prevalence Survey. African Journal of Clinical and Experimental Microbiology, 22, 260-272. https://doi.org/10.4314/ajcem.v22i2.19
[22]
Fenny, A.P., Yates, R. and Thompson, R. (2018) Social Health Insurance Schemes in Africa Leave out the Poor. International Health, 10, 1-3. https://doi.org/10.1093/inthealth/ihx046
[23]
Morgan, D.J., Malani, P.N. and Diekema, D.J. (2023) Diagnostic Stewardship to Prevent Diagnostic Error. JAMA, 329, 1255-1256. https://doi.org/10.1001/jama.2023.1678
[24]
World Health Organization (2016) Diagnostic Stewardship, a Guide to Implementation in Antimicrobial Resistance Surveillance Sites. https://apps.who.int/iris/bitstream/handle/10665/251553/WHO-DGO-AMR-2016.3-eng.pdf
[25]
Naidoo, D. and Ihekweazu, C. (2020) Nigeria’s Efforts to Strengthen Laboratory Diagnostics—Why Access to Reliable and Affordable Diagnostics Is Key to Building Resilient Laboratory Systems. African Journal of Laboratory Medicine, 9, a1019. https://doi.org/10.4102/ajlm.v9i2.1019
[26]
Palavecino, E.L., Williamson, J.C. and Ohl, C.A. (2020) Collaborative Antimicrobial Stewardship: Working with Microbiology. Infectious Disease Clinics, 34, 51-65. https://doi.org/10.1016/j.idc.2019.10.006
