Fowotade A, Fasuyi T, Aigbovo O, Versporten A, Adekanmbi O, Akinyemi O, Goossens H, Kehinde A, Oduyebo O
Department of Medical Microbiology, University College Hospital, Ibadan, Nigeria.
Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
West Afr J Med. 2020 Jul-Aug;37(3):216-220.
Antimicrobial resistance is a global health challenge. There is inadequate information on antimicrobial prescribing practices in many sub-Saharan African countries including Nigeria. A standardized method for surveillance of antimicrobial use in hospitals was employed to assess the antimicrobial prescribing practices in UCH, Ibadan, Nigeria.
A point prevalence survey (PPS) was conducted in December 15, 2017 at the UCH Ibadan. The survey included all in-patients receiving an antimicrobial on the day of PPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment as well as a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp (www.global-pps.be).
This survey included 451 patients from 38 different wards of which 59.6% received at least one antimicrobial. The neonatal medical wards contributed the highest number of patients who received antibiotics. A total of 172 therapeutic antibiotic prescriptions were issued, mainly for Community Acquired Infections (n=119; 69.2%). Most prescriptions for Healthcare Associated Infections (n=53) were intervention related (47.2%). Frequently used antibiotics include third generation cephalosporins (23.9%; mainly ceftriaxone); followed by combination of penicillin's (17.4%; mainly amoxicillin with enzyme inhibitor) and fluoroquinolones (16.6%). Majority, 312(69.9%)of the patients had parenteral antibiotics and only 95 (21.3%) of all antibiotic prescriptions had a documented stop or review date. Although the reason for antibiotic prescription was indicated for 413 (92.4%) prescriptions, targeted therapy was the basis for only 17 (3.8%)of these prescriptions. For surgical prophylaxis, 98.7% of all prescriptions were given for more than one day. Compliance to guidelines was non-existent.
Our findings showed high broad spectrum prescribing, high number of intervention related health care infections, high use of prolonged surgical prophylaxis, inexistence of local guidelines; and low utilization of laboratory facilities. Hospital related intervention should include development of antibiotic guideline and increased enlightenment on rational prescribing practices.
抗菌药物耐药性是一项全球性的健康挑战。在包括尼日利亚在内的许多撒哈拉以南非洲国家，关于抗菌药物处方行为的信息不足。采用一种标准化的医院抗菌药物使用监测方法来评估尼日利亚伊巴丹大学医院（UCH）的抗菌药物处方行为。
2017年12月15日在伊巴丹大学医院进行了一项现患率调查（PPS）。该调查包括在PPS当天正在接受抗菌药物治疗的所有住院患者。收集的数据包括抗菌药物的详细信息、治疗原因和指征以及一系列质量指标。使用由安特卫普大学设计的基于网络的应用程序（www.global - pps.be）进行数据录入、验证和报告。
本次调查纳入了来自38个不同病房的451名患者，其中59.6%的患者至少接受了一种抗菌药物。新生儿内科病房接受抗生素治疗的患者数量最多。共开出了172份治疗性抗生素处方，主要用于社区获得性感染（n = 119；69.2%）。大多数医疗保健相关感染的处方（n = 53）与干预有关（47.2%）。常用抗生素包括第三代头孢菌素（23.9%；主要是头孢曲松）；其次是青霉素类联合用药（17.4%；主要是阿莫西林与酶抑制剂）和氟喹诺酮类（16.6%）。大多数患者（312例，69.9%）接受了静脉用抗生素，所有抗生素处方中只有95份（21.3%）记录了停药或复查日期。虽然413份（92.4%）处方注明了抗生素处方原因，但其中只有17份（3.8%）是以靶向治疗为依据的。对于外科预防用药，所有处方中有98.7%使用超过一天。不存在遵循指南的情况。
我们的研究结果显示广谱处方率高、与干预相关的医疗保健感染数量多、长期外科预防用药使用率高、缺乏当地指南以及实验室设施利用率低。医院相关干预措施应包括制定抗生素指南并加强对合理处方行为的宣传教育。
