Oyemolade Toyin A, Malomo Toluyemi A, Adeleye Amos O
Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria.
Department of Surgery, Division of Neurological Surgery, College of Medicine, University of Ibadan, and University College Hospital, UCH, Ibadan, Nigeria.
J Neurosci Rural Pract. 2019 Oct;10(4):653-656. doi: 10.1055/s-0039-3399591. Epub 2019 Dec 11.
In Nigeria, pre-neurosurgical care of most neurotrauma patients usually involves administration of many empirical agents including antibiotics with no apparent indications. This practice is fraught with two particular dangers: increase in health care costs and development of drug resistance. This study aimed to interrogate antibiotic stewardship in the pre-neurosurgical care of neurotrauma patients referred to our practice. This 7-month prospective descriptive study was performed in one University Teaching Hospital of a developing country. Clinical data on all admitted neurotrauma patients with information on the pre-neurosurgical treatment received were captured and analyzed. There were 113 patients, 87(77.0%) males; 103(91.2%) had head injury, and 10(8.8%) spinal cord injury. Associated systemic injuries occurred in 47(41.6%): 40 involved skeletal and soft tissue systems, and 12(10.6%) presented with aspiration pneumonitis. These patients were referrals from public health facilities including primary health facilities (PHF), secondary (SHF), and tertiary (THF), as well as private clinics (PC). Antibiotics were given to 74 (65.5%) patients, with a probabilistic indication in only 17.6% (13/74) of these. The proportional distribution of this antibiotic administration according to the referral base was not statistically significant (χ =6.87, = 0.3): 70% (14/20) from PHF, 56% (14/25) from SHF, 71% (23/32) from THF, and 63% (23/36) from PC. The antimicrobial agent administered was specified in 40 cases: Ceftriaxone was the commonest antibiotic agent implicated. There is apparent unnecessary exposure of patients to antibiotics in the pre-neurosurgical care of neurotrauma in this study. There is, therefore, need for education on antibiotic stewardship to the group of health workers involved.
在尼日利亚，大多数神经创伤患者的神经外科术前护理通常涉及使用多种经验性药物，包括无明显指征的抗生素。这种做法存在两个特殊风险：医疗成本增加和耐药性的产生。本研究旨在调查转诊至我们科室的神经创伤患者神经外科术前护理中的抗生素管理情况。这项为期7个月的前瞻性描述性研究在一个发展中国家的大学教学医院进行。收集并分析了所有入院神经创伤患者的临床数据，包括术前接受治疗的信息。共有113例患者，其中男性87例（77.0%）；103例（91.2%）有头部损伤，10例（8.8%）有脊髓损伤。47例（41.6%）伴有全身损伤：40例涉及骨骼和软组织系统，12例（10.6%）出现吸入性肺炎。这些患者来自公共卫生机构，包括初级卫生机构（PHF）、二级卫生机构（SHF）和三级卫生机构（THF），以及私人诊所（PC）。74例（65.5%）患者使用了抗生素，其中仅有17.6%（13/74）有使用抗生素的可能性指征。根据转诊机构划分，抗生素使用情况的比例分布无统计学意义（χ² = 6.87，P = 0.3）：来自PHF的患者中70%（14/20）使用了抗生素，来自SHF的患者中56%（14/25）使用了抗生素，来自THF的患者中71%（23/32）使用了抗生素，来自PC的患者中63%（23/36）使用了抗生素。40例患者明确了所使用的抗菌药物：头孢曲松是最常使用的抗生素。本研究表明，在神经创伤患者的神经外科术前护理中，患者明显不必要地暴露于抗生素之下。因此，有必要对相关医护人员进行抗生素管理方面的教育。
