Antibiotic use among hospitalized adult patients in a setting with limited laboratory infrastructure in Freetown Sierra Leone, 2017–2018

Our study aimed to assess antibiotic use in adult inpatients in the context of limited laboratory services at the main tertiary hospital in Sierra Leone. A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. A to...

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Bibliographic Details
Published in:International journal of infectious diseases 2020-01, Vol.90, p.71-76
Main Authors: Lakoh, Sulaiman, Adekanmbi, Olukemi, Jiba, Darlinda F., Deen, Gibrilla F., Gashau, Wadzani, Sevalie, Stephen, Klein, Eili Y.
Format: Article
Language:English
Subjects:
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotic resistance
Antimicrobial stewardship
Cephalosporins - therapeutic use
Clinical Laboratory Services
Cross-Sectional Studies
Female
Hospitalization
Humans
Imidazoles - therapeutic use
Inpatients
Laboratory
Male
Middle Aged
Penicillins - therapeutic use
Sierra Leone
Young Adult
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Summary:Our study aimed to assess antibiotic use in adult inpatients in the context of limited laboratory services at the main tertiary hospital in Sierra Leone. A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. A total of 920 patients were interviewed, of which 753 (81.8%) had at least one antibiotic. Complete data was captured for 688 (91.0%) patients. The median age was 41 years and 52.8% were male. Fever was reported in 41.5% of patients, though 85.1% had no leukocyte count prior to antibiotic use and none had a bacterial culture. Indications for prescribing were surgical prophylaxis (15.7%), pneumonia (15.1%), and trauma (5.8%). Cephalosporins (25.9%), penicillins (23.2%), and imidazoles (20.8%) were commonly prescribed. We found high rates of antibiotic use, of which most was not based on laboratory evidence. Lack of oversight and microbiological support are drivers of poor prescribing in many developing countries, which lack financial resources and serve a sicker population. Greater investments are needed to establish antimicrobial stewardship programs and provide clinicians with diagnostic support to enable improvements in patient outcomes and curb the spread of antibiotic resistance.
ISSN:1201-9712
1878-3511
DOI:10.1016/j.ijid.2019.10.022