Point prevalence study of antimicrobial use among hospitals across Botswana: findings and implications

Bene D Anand Paramadhas, Celda Tiroyakgosi, Pinkie Mpinda-Joseph, Mathudi Morokotso, Matshediso Matome, Fatima Sinkala, Mavis Gaolebe, Brighid Malone, Emmanuel Molosiwa, Muthu Guhan Shanmugam, Gogaisa Pearl Raseatlholo, Joyce Masilo, Yomi Oyeniran, Stella Marumoloa, Omphile Glory Maakelo, Ishmael Katjakae, Joyce Kgatlwane, Brian Godman, Amos Massele

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.

LanguageEnglish
Pages535-546
Number of pages12
JournalExpert Review of Anti-infective Therapy
Volume17
Issue number7
Early online date1 Jul 2019
DOIs
Publication statusPublished - 3 Jul 2019

Fingerprint

Botswana
Cross-Sectional Studies
Anti-Bacterial Agents
Surgical Wound Infection
HIV
Communicable Diseases
Community-Acquired Infections
Private Hospitals
Disease Resistance
Cefotaxime
Ceftriaxone
Public Hospitals
Metronidazole
Malnutrition
Malaria
Catheters
Surveys and Questionnaires

Keywords

  • antibiotics
  • Botswana
  • point prevalence study
  • hospitals
  • drugs and therapeutic committees
  • antimicrobial stewardship programmes

Cite this

Paramadhas, B. D. A., Tiroyakgosi, C., Mpinda-Joseph, P., Morokotso, M., Matome, M., Sinkala, F., ... Massele, A. (2019). Point prevalence study of antimicrobial use among hospitals across Botswana: findings and implications. Expert Review of Anti-infective Therapy, 17(7), 535-546. https://doi.org/10.1080/14787210.2019.1629288
Paramadhas, Bene D Anand ; Tiroyakgosi, Celda ; Mpinda-Joseph, Pinkie ; Morokotso, Mathudi ; Matome, Matshediso ; Sinkala, Fatima ; Gaolebe, Mavis ; Malone, Brighid ; Molosiwa, Emmanuel ; Shanmugam, Muthu Guhan ; Raseatlholo, Gogaisa Pearl ; Masilo, Joyce ; Oyeniran, Yomi ; Marumoloa, Stella ; Maakelo, Omphile Glory ; Katjakae, Ishmael ; Kgatlwane, Joyce ; Godman, Brian ; Massele, Amos. / Point prevalence study of antimicrobial use among hospitals across Botswana : findings and implications. In: Expert Review of Anti-infective Therapy. 2019 ; Vol. 17, No. 7. pp. 535-546.
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Paramadhas, BDA, Tiroyakgosi, C, Mpinda-Joseph, P, Morokotso, M, Matome, M, Sinkala, F, Gaolebe, M, Malone, B, Molosiwa, E, Shanmugam, MG, Raseatlholo, GP, Masilo, J, Oyeniran, Y, Marumoloa, S, Maakelo, OG, Katjakae, I, Kgatlwane, J, Godman, B & Massele, A 2019, 'Point prevalence study of antimicrobial use among hospitals across Botswana: findings and implications' Expert Review of Anti-infective Therapy, vol. 17, no. 7, pp. 535-546. https://doi.org/10.1080/14787210.2019.1629288

Point prevalence study of antimicrobial use among hospitals across Botswana : findings and implications. / Paramadhas, Bene D Anand; Tiroyakgosi, Celda; Mpinda-Joseph, Pinkie ; Morokotso, Mathudi ; Matome, Matshediso; Sinkala, Fatima; Gaolebe, Mavis ; Malone, Brighid; Molosiwa, Emmanuel ; Shanmugam, Muthu Guhan ; Raseatlholo, Gogaisa Pearl ; Masilo, Joyce; Oyeniran, Yomi ; Marumoloa, Stella; Maakelo, Omphile Glory ; Katjakae, Ishmael ; Kgatlwane, Joyce ; Godman, Brian; Massele, Amos.

In: Expert Review of Anti-infective Therapy, Vol. 17, No. 7, 03.07.2019, p. 535-546.

Research output: Contribution to journalArticle

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T1 - Point prevalence study of antimicrobial use among hospitals across Botswana

T2 - Expert Review of Anti-infective Therapy

AU - Paramadhas, Bene D Anand

AU - Tiroyakgosi, Celda

AU - Mpinda-Joseph, Pinkie

AU - Morokotso, Mathudi

AU - Matome, Matshediso

AU - Sinkala, Fatima

AU - Gaolebe, Mavis

AU - Malone, Brighid

AU - Molosiwa, Emmanuel

AU - Shanmugam, Muthu Guhan

AU - Raseatlholo, Gogaisa Pearl

AU - Masilo, Joyce

AU - Oyeniran, Yomi

AU - Marumoloa, Stella

AU - Maakelo, Omphile Glory

AU - Katjakae, Ishmael

AU - Kgatlwane, Joyce

AU - Godman, Brian

AU - Massele, Amos

PY - 2019/7/3

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N2 - Objective: There is an urgent need to undertake Point Prevalence Surveys (PPS) across Africa to document antimicrobial utilisation rates given high rates of infectious diseases and growing resistance rates. This is the case in Botswana along with high empiric use and extended prophylaxis to prevent surgical site infections (SSIs) Method: PPS was conducted among all hospital sectors in Botswana using forms based on Global and European PPS studies adapted for Botswana, including rates of HIV, TB, malaria, and malnutrition. Quantitative study to assess the capacity to promote appropriate antibiotic prescribing. Results: 711 patients were enrolled with high antimicrobial use (70.6%) reflecting an appreciable number transferred from other hospitals (42.9%), high HIV rates (40.04% among those with known HIV) and TB (25.4%), and high use of catheters. Most infections were community acquired (61.7%). Cefotaxime and metronidazole were the most prescribed in public hospitals with ceftriaxone the most prescribed antimicrobial in private hospitals. Concerns with missed antibiotic doses (1.96 per patient), high empiric use, extended use to prevent SSIs, high use of IV antibiotics, and variable infrastructures in hospitals to improve future antibiotic use. Conclusion: High antibiotic use reflects high rates of infectious diseases observed in Botswana. A number of concerns have been identified, which are being addressed.

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