Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
PLoS One. 2019 Aug 5;14(8):e0220261. doi: 10.1371/journal.pone.0220261. eCollection 2019.
Excessive use of antibiotics, especially watch group antibiotics such as ceftriaxone leads to emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries (LMICs), antibiotics are overused but data on consumption is scarcely available. We aimed at determining the extent and predictors of ceftriaxone use in a tertiary care university teaching hospital in Kilimanjaro, Tanzania. A hospital-based cross-sectional study was conducted from August 2013 through August 2015. Patients admitted in the medical, surgical wards and their respective intensive care units, receiving antimicrobials and other medications for various ailments were enrolled. Socio-demographic and clinical data were recorded in a structured questionnaire from patients' files and logistic regression was performed to determine the predictors for ceftriaxone use. Out of the 630 patients included in this study, 322 (51.1%) patients were on ceftriaxone during their time of hospitalization. Twenty-two patients out of 320 (6.9%) had been on ceftriaxone treatment without evidence of infection. Ceftriaxone use for surgical prophylaxis was 44 (40.7%), of which 32 (72.7%) and 9 (20.5%) received ceftriaxone prophylaxis before and after surgery, respectively. Three (6.8%) received ceftriaxone prophylaxis during surgery. Predicting factors for that the health facility administered ceftriaxone were identified as history of any medication use before referral to hospital [OR = 3.4, 95% CI (1.0-11.4), p = 0.047], bacterial infection [OR = 18.0, 95% CI (1.4-225.7, p = 0.025)], surgical ward [OR = 2.9, 95% CI (0.9-9.4), p = 0.078] and medical wards [OR = 5.0, 95% CI (0.9-28.3), p = 0.070]. Overall, a high ceftriaxone use at KCMC hospital was observed. Antimicrobial stewardship programs are highly needed to monitor and regulate hospital antimicrobial consumption, which in turn could help in halting the rising crisis of antimicrobial resistance.
过度使用抗生素，尤其是头孢曲松等广谱抗生素，导致了抗菌药物耐药性（AMR）的出现和传播。在中低收入国家（LMICs），抗生素被过度使用，但有关消耗的数据却很少。我们旨在确定坦桑尼亚乞力马扎罗省一所三级教学医院中头孢曲松的使用程度和预测因素。这是一项基于医院的横断面研究，于 2013 年 8 月至 2015 年 8 月进行。招募了在医疗、外科病房及其各自的重症监护病房住院、接受各种疾病的抗生素和其他药物治疗的患者。从患者档案中的结构化问卷中记录了社会人口统计学和临床数据，并进行了逻辑回归分析，以确定头孢曲松使用的预测因素。在这项研究中，纳入了 630 名患者，其中 322 名（51.1%）患者在住院期间使用了头孢曲松。在 320 名使用头孢曲松治疗的患者中，有 22 名（6.9%）没有感染的证据。头孢曲松用于外科预防的比例为 44（40.7%），其中 32（72.7%）和 9（20.5%）分别在手术前和手术后接受了头孢曲松预防。3 名（6.8%）在手术期间接受了头孢曲松预防。确定医疗机构使用头孢曲松的预测因素包括在转诊至医院之前使用任何药物的病史[比值比（OR）=3.4，95%置信区间（CI）（1.0-11.4），p=0.047]、细菌感染[OR=18.0，95%CI（1.4-225.7），p=0.025]、外科病房[OR=2.9，95%CI（0.9-9.4），p=0.078]和内科病房[OR=5.0，95%CI（0.9-28.3），p=0.070]。总体而言，KCMC 医院头孢曲松的使用量很高。非常需要开展抗菌药物管理计划，以监测和规范医院抗菌药物的使用，这反过来有助于阻止抗菌药物耐药性不断上升的危机。
