Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey

Antoinette A. A. Bediako-Bowan; Enid Owusu; Appiah-Korang Labi; Noah Obeng-Nkrumah; Gifty Sunkwa-Mills; Stephanie Bjerrum; Japheth Awuletey Opintan; Cynthia Bannerman; Kåre Mølbak; Jørgen Anders Lindholm Kurtzhals; Mercy Jemima Newman

doi:10.1186/s12889-019-7162-x

Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey

Antoinette A. A. Bediako-Bowan, Enid Owusu, Appiah-Korang Labi, Noah Obeng-Nkrumah, Gifty Sunkwa-Mills, Stephanie Bjerrum, Japheth Awuletey Opintan, Cynthia Bannerman, Kåre Mølbak, Jørgen Anders Lindholm Kurtzhals, Mercy Jemima Newman

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Abstract

BACKGROUND: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana.

METHODS: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units.

RESULTS: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples.

CONCLUSION: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.

Original language	English
Article number	797
Journal	BMC Public Health
Volume	19
Issue number	1
Number of pages	10
ISSN	1471-2458
DOIs	https://doi.org/10.1186/s12889-019-7162-x
Publication status	Published - 21 Jun 2019

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Bediako-Bowan, A. A. A., Owusu, E., Labi, A.-K., Obeng-Nkrumah, N., Sunkwa-Mills, G., Bjerrum, S., Opintan, J. A., Bannerman, C., Mølbak, K., Kurtzhals, J. A. L., & Newman, M. J. (2019). Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey. BMC Public Health, 19(1), Article 797. https://doi.org/10.1186/s12889-019-7162-x

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title = "Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey",

abstract = "BACKGROUND: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana.METHODS: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units.RESULTS: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples.CONCLUSION: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.",

author = "Bediako-Bowan, {Antoinette A. A.} and Enid Owusu and Appiah-Korang Labi and Noah Obeng-Nkrumah and Gifty Sunkwa-Mills and Stephanie Bjerrum and Opintan, {Japheth Awuletey} and Cynthia Bannerman and K{\aa}re M{\o}lbak and Kurtzhals, {J{\o}rgen Anders Lindholm} and Newman, {Mercy Jemima}",

year = "2019",

month = jun,

day = "21",

doi = "10.1186/s12889-019-7162-x",

language = "English",

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journal = "BMC Public Health",

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TY - JOUR

T1 - Antibiotic use in surgical units of selected hospitals in Ghana

T2 - a multi-centre point prevalence survey

AU - Bediako-Bowan, Antoinette A. A.

AU - Owusu, Enid

AU - Labi, Appiah-Korang

AU - Obeng-Nkrumah, Noah

AU - Sunkwa-Mills, Gifty

AU - Bjerrum, Stephanie

AU - Opintan, Japheth Awuletey

AU - Bannerman, Cynthia

AU - Mølbak, Kåre

AU - Kurtzhals, Jørgen Anders Lindholm

AU - Newman, Mercy Jemima

PY - 2019/6/21

Y1 - 2019/6/21

N2 - BACKGROUND: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana.METHODS: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units.RESULTS: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples.CONCLUSION: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.

AB - BACKGROUND: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana.METHODS: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units.RESULTS: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples.CONCLUSION: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including antibiotics for prophylactic purposes and the majority was started without supporting microbiological analysis. Prescription practices that encourage rational use of antibiotics guided by microbiology and enforcement of antibiotic policy guidelines should be the target for future interventions.

U2 - 10.1186/s12889-019-7162-x

DO - 10.1186/s12889-019-7162-x

M3 - Journal article

C2 - 31226974

SN - 1471-2458

VL - 19

JO - BMC Public Health

JF - BMC Public Health

IS - 1

M1 - 797

ER -

Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey

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