Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications

Caleb Okoth, Sylvia Opanga, Faith Okalebo, Margaret Oluka, Amanj Baker Kurdi, Brian Godman

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and aims: A substantial amount of antibiotic use in hospitals may be inappropriate, potentially leading to the development and spread of antibiotic resistance, adverse effects, mortality and increased hospital costs. The objective was to assess current patterns of antibiotic use in a leading referral hospital in Western Kenya. This would lead to the identification of opportunities for quality improvement in this hospital and across Kenya. Methodology: A point prevalence survey was carried out with data abstracted principally from patient medical records supplemented by interviews from physicians when needed. The pattern of antibiotic use was analyzed by descriptive methods. Differences in antibiotic use and indications between the selected wards were compared using the Chi-square test or Fisher’s exact tests. Results: Among the patients surveyed, 67.7% were on antibiotics. The most common classes of antibiotics prescribed were third generation cephalosporins (55%), imidazole derivatives like metronidazole (41.8%) and broad spectrum penicillins (41.8%). The most common indication for antibiotic use was medical prophylaxis (29%), with local guidelines advocating antibiotic prophylaxis in mothers after delivery of their child as well as in neonates with birth asphyxia and low weight at birth. Dosing of antibiotics was seen as generally optimal when assessed against current recommendations. Conclusion: Whilst the dosing of antibiotics seemed adequate, there was high use of antibiotics in this hospital. This needs to be urgently reviewed with current appreciable empiric antibiotic use. Programmes are being instigated to address these concerns including developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities.
LanguageEnglish
Pages128-136
Number of pages9
JournalHospital Practice
Volume46
Issue number3
Early online date27 Apr 2018
DOIs
Publication statusPublished - 20 Aug 2018

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Kenya
Microbial Drug Resistance
Referral and Consultation
Anti-Bacterial Agents
Low Birth Weight Infant
Surveys and Questionnaires
Guidelines
Formularies
Antibiotic Prophylaxis
Hospital Costs
Asphyxia
Metronidazole
Cephalosporins
Chi-Square Distribution
Quality Improvement
Penicillins
Medical Records
Mothers
Newborn Infant
Interviews

Keywords

  • antibiotics
  • resistance
  • point prevalence study
  • Kenya

Cite this

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title = "Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications",
abstract = "Background and aims: A substantial amount of antibiotic use in hospitals may be inappropriate, potentially leading to the development and spread of antibiotic resistance, adverse effects, mortality and increased hospital costs. The objective was to assess current patterns of antibiotic use in a leading referral hospital in Western Kenya. This would lead to the identification of opportunities for quality improvement in this hospital and across Kenya. Methodology: A point prevalence survey was carried out with data abstracted principally from patient medical records supplemented by interviews from physicians when needed. The pattern of antibiotic use was analyzed by descriptive methods. Differences in antibiotic use and indications between the selected wards were compared using the Chi-square test or Fisher’s exact tests. Results: Among the patients surveyed, 67.7{\%} were on antibiotics. The most common classes of antibiotics prescribed were third generation cephalosporins (55{\%}), imidazole derivatives like metronidazole (41.8{\%}) and broad spectrum penicillins (41.8{\%}). The most common indication for antibiotic use was medical prophylaxis (29{\%}), with local guidelines advocating antibiotic prophylaxis in mothers after delivery of their child as well as in neonates with birth asphyxia and low weight at birth. Dosing of antibiotics was seen as generally optimal when assessed against current recommendations. Conclusion: Whilst the dosing of antibiotics seemed adequate, there was high use of antibiotics in this hospital. This needs to be urgently reviewed with current appreciable empiric antibiotic use. Programmes are being instigated to address these concerns including developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities.",
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Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya : findings and implications. / Okoth, Caleb ; Opanga, Sylvia; Okalebo, Faith; Oluka, Margaret; Kurdi, Amanj Baker; Godman, Brian.

In: Hospital Practice, Vol. 46, No. 3, 20.08.2018, p. 128-136.

Research output: Contribution to journalArticle

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AU - Opanga, Sylvia

AU - Okalebo, Faith

AU - Oluka, Margaret

AU - Kurdi, Amanj Baker

AU - Godman, Brian

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N2 - Background and aims: A substantial amount of antibiotic use in hospitals may be inappropriate, potentially leading to the development and spread of antibiotic resistance, adverse effects, mortality and increased hospital costs. The objective was to assess current patterns of antibiotic use in a leading referral hospital in Western Kenya. This would lead to the identification of opportunities for quality improvement in this hospital and across Kenya. Methodology: A point prevalence survey was carried out with data abstracted principally from patient medical records supplemented by interviews from physicians when needed. The pattern of antibiotic use was analyzed by descriptive methods. Differences in antibiotic use and indications between the selected wards were compared using the Chi-square test or Fisher’s exact tests. Results: Among the patients surveyed, 67.7% were on antibiotics. The most common classes of antibiotics prescribed were third generation cephalosporins (55%), imidazole derivatives like metronidazole (41.8%) and broad spectrum penicillins (41.8%). The most common indication for antibiotic use was medical prophylaxis (29%), with local guidelines advocating antibiotic prophylaxis in mothers after delivery of their child as well as in neonates with birth asphyxia and low weight at birth. Dosing of antibiotics was seen as generally optimal when assessed against current recommendations. Conclusion: Whilst the dosing of antibiotics seemed adequate, there was high use of antibiotics in this hospital. This needs to be urgently reviewed with current appreciable empiric antibiotic use. Programmes are being instigated to address these concerns including developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities.

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