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Kamara IF, Kanu J, Maruta A, Fofanah BD, Kamara KN, Sheriff B, Katawera V, D'Almeida SA, Musoke R, Nuwagira I, Lakoh S, Kamara RZ, Tengbe SM, Mansaray AR, Koroma Z, Thomas F, Abiri OT, Koroma AT, Russell JBW, Squire J, Vandi MA. Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology. BMJ Open 2023; 13:e078367. [PMID: 38159961 PMCID: PMC10759135 DOI: 10.1136/bmjopen-2023-078367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone. DESIGN We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology. SETTING The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services. PARTICIPANTS All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURES Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done. RESULTS Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%). CONCLUSION There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Joseph Kanu
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- Community Health, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | | | - Kadijatu Nabie Kamara
- National Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Victoria Katawera
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Selassi A D'Almeida
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Robert Musoke
- Emergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra Leone
| | | | - Abdul Razak Mansaray
- Laboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Onome T Abiri
- Pharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Pharmacology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Aminata Tigiedankay Koroma
- National Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - James Squire
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Alex Vandi
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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Lakoh S, Yi L, Russell JBW, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Adekanmbi O, Jiba DF, Kamara MN, Sesay D, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study. BMC Res Notes 2023; 16:301. [PMID: 37907960 PMCID: PMC10619308 DOI: 10.1186/s13104-023-06591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Catheter-associated urinary tract infections (CAUTI) are common worldwide, but due to limited resources, its actual burden in low-income countries is unknown. Currently, there are gaps in knowledge about CAUTI due to lack of surveillance activities in Sierra Leone. In this prospective cohort study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in two tertiary hospitals in different regions of Sierra Leone. RESULTS The mean age of the 459 recruited patients was 48.8 years. The majority were females (236, 51.3%). Amongst the 196 (42.6%) catheterized patients, 29 (14.8%) developed CAUTI. Bacterial growth was reported in 32 (84%) patients. Escherichia coli (14, 23.7%), Klebsiella pneumoniae (10, 17.0%), and Klebsiella oxytoca (8, 13.6%) were the most common isolates. Most isolates were ESBL-producing Enterobacteriaceae (33, 56%) and WHO Priority 1 (Critical) pathogens (38, 71%). Resistance of K. pneumoniae, K. oxytoca, E. coli, and Proteus mirabilis was higher with the third-generation cephalosporins and penicillins but lower with carbapenems, piperacillin-tazobactam and amikacin. To reduce the high incidence of CAUTI and multi-drug resistance organisms, urgent action is needed to strengthen the microbiology diagnostic services and develop and implement catheter bundles that provide clear guidance for catheter insertion, care and removal.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Le Yi
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone.
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- , SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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3
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Lakoh S, Williams CEE, Sevalie S, Russell JBW, Conteh SK, Kanu JS, Barrie U, Deen GF, Maruta A, Sesay D, Adekanmbi O, Jiba DF, Okeibunor JC, Yendewa GA, Firima E. Antibiotic use and consumption among medical patients of two hospitals in Sierra Leone: a descriptive report. BMC Infect Dis 2023; 23:737. [PMID: 37891476 PMCID: PMC10612171 DOI: 10.1186/s12879-023-08517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone. METHODS This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021. After admission to the medical or intensive care unit, patients were sequentially recruited by a nurse from each hospital. Demographic and clinical characteristics and information on the dose of antibiotics, their routes, and frequency of administration and duration were collected using a questionnaire adapted from previous studies and encrypted in EpiCollect software (Epic, Verona WI). A physician reviews and verifies each completed questionnaire. Data analysis was done using STATA version 16. RESULTS The mean age of the 468 patients evaluated in this study was 48.6 years. The majority were women (241, 51.7%) and treated at MGH (245, 52.0%). Clinical diagnosis of bacterial infection was made in only 180 (38.5%) patients. Regardless of the diagnosis, most (442, 94.9%) patients received at least one antibiotic. Of a total 813 doses of antibiotics prescribed by the two hospitals, 424 (52.2%) were administered in MH. Overall, antibiotic consumption was 66.9 defined daily doses (DDDs) per 100 bed-days, with ceftriaxone being the most commonly used antibiotic (277, 34.1%). The ACCESS and WATCH antibiotics accounted for 18.9 DDDs per 100 bed-days (28.2%) and 48.0 DDDs per 100 bed-days (71.7%), respectively. None of the patients were prescribed a RESERVE antibiotics. The antibiotic consumption was lower in MH (61.3 DDDs per 100 bed-days) than MGH (76.5 DDDs per 100 bed-days). CONCLUSION Antibiotic consumption was highest with ceftriaxone, followed by levofloxacin and metronidazole. Given the high rate of consumption of antibiotics in the WATCH category of the AWaRe classification, there is a need to initiate surveillance of antibiotic consumption and establish hospital-based antibiotic stewardship in these settings.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone.
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone.
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone.
- Infectious Disease Research Network, Freetown, Sierra Leone.
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- 34 Military Hospital, Freetown, Sierra Leone
| | - James B W Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Sarah K Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, New England, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone
| | - Daniel Sesay
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, OH, Cleveland, USA
- Johns Hopkins Bloomberg School of Public Health, MD, Baltimore, USA
| | - Emmanuel Firima
- Department of Medicine, Clinical Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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Kpagoi SSTK, Kamara KN, Carshon-Marsh R, Delamou A, Manzi M, Kamara RZ, Moiwo MM, Kamara M, Koroma Z, Lakoh S, Fofanah BD, Kamara IF, Kanu ABJ, Kenneh S, Kanu JS, Margao S, Kamau EM. Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021. Trop Med Infect Dis 2023; 8:385. [PMID: 37624323 PMCID: PMC10458420 DOI: 10.3390/tropicalmed8080385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Surgical site infections (SSIs) are a major public health threat to the success of surgery. This study assessed changes in SSIs and use of antibiotics among caesarean section (CS) and herniorrhaphy patients at a regional hospital in Sierra Leone following operational research. This was a comparative before and after study using routine hospital data. The study included all the CS and herniorrhaphy patients who underwent surgery between two time periods. Of the seven recommendations made in the first study, only one concerning improving the hospital's records and information system was fully implemented. Three were partially implemented and three were not implemented. The study population in both studies showed similar socio-demographic characteristics. The use of postoperative antibiotics for herniorrhaphy in both studies remained the same, although a significant increase was found for both pre- and postoperative antibiotic use in the CS patients, 589/596 (98.8%) in 2023 and 417/599 (69.6%) in 2021 (p < 0.001). However, a significant decrease was observed in the overall incidence of SSIs, 22/777 (2.8%) in 2023 and 46/681 (6.7%) in 2021 (p < 0.001), and the incidence of SSIs among the CS patients, 15/596 (2.5%) in 2023 and 45/599 (7.5%) in 2021 (p < 0.001). The second study highlights the potential value of timely assessment of the implementation of recommendations following operational research.
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Affiliation(s)
- Satta Sylvia Theresa Kumba Kpagoi
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- Department of Nursing, School of Community Health Sciences, Bo Campus, Njala University, Bo 00232, Sierra Leone
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Ronald Carshon-Marsh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry 00224, Guinea;
| | | | - Rugiatu Z. Kamara
- United States Centers for Disease Control and Prevention, Public Health Emergency Operations Center, Freetown 00232, Sierra Leone;
| | - Matilda Mattu Moiwo
- Ministry of Defense, Republic of Sierra Leone Armed Forces, Freetown 00232, Sierra Leone;
| | - Matilda Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Zikan Koroma
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, 21A-B Riverside Drive, Freetown 00232, Sierra Leone; (B.D.F.); (I.F.K.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21A-B Riverside Drive, Freetown 00232, Sierra Leone; (B.D.F.); (I.F.K.)
| | - Alex Bumble John Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Senesie Margao
- Ministry of Health and Sanitation, Government of Sierra Leone (SL), Freetown 00232, Sierra Leone; (K.N.K.); (R.C.-M.); (Z.K.); (S.L.); (A.B.J.K.); (S.K.); (J.S.K.); (S.M.)
| | - Edward Mberu Kamau
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO), 1211 Geneva, Switzerland;
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5
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Lakoh S, John-Cole V, Luke RD, Bell N, Russell JB, Mustapha A, Barrie U, Abiri OT, Coker JM, Kamara MN, Coker FJ, Adekanmbi O, Kamara IF, Fofanah BD, Jiba DF, Adeniji AO, Kenneh S, Deen GF, Moon TD, Yendewa GA, Firima E. Antibiotic use and consumption in Freetown, Sierra Leone: A baseline report of prescription stewardship in outpatient clinics of three tertiary hospitals. IJID REGIONS 2023; 7:43-51. [PMID: 37038468 PMCID: PMC10082370 DOI: 10.1016/j.ijregi.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Objective As there are no country-representative data on bacterial sensitivities to guide antimicrobial stewardship (AMS) interventions, an AMS programme was established in the outpatient clinics of three tertiary hospitals in Freetown, Sierra Leone. Methods The study employed a cross-sectional design to collect antibiotic prescribing data from 370 pregnant women and lactating mothers, 314 children and 229 regular patients in the outpatient clinics of the Princess Christian Maternity Hospital (PCMH), Ola During Children's Hospital and Connaught Hospital (CH), respectively, in April 2022. All data were analysed using Stata Version 16. Results Of 913 patients, most were female (n=635, 69.5%), treated at PCMH (n=370, 40.5%) and had a bacterial infection (n=661, 72.4%). The indication for prescribing antibiotics was inappropriate in 252 (27.6%) patients. Of the 1236 prescriptions, 393 (31.8%) were made at CH. The duration of antibiotic use was not stated in 230 (18.6%) prescriptions. Overall antibiotic consumption was 55.3 defined daily doses per 1000 outpatient-days. Conclusion Gaps in antibiotic prescriptions were identified in the outpatient clinics of three national referral hospitals in Sierra Leone. In order to combat antimicrobial resistance, AMS interventions are needed to reduce the prescription of antibiotics for inappropriate indications or without specified duration.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Sustainable Health Systems Sierra Leone, Freetown, Sierra Leone
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Valerie John-Cole
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ronita D.C. Luke
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Nellie Bell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - James B.W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Ayeshatu Mustapha
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Onome T. Abiri
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Joshua M. Coker
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Freddie J. Coker
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Adetunji O. Adeniji
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Department of Obstetrics & Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Troy D. Moon
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emmanuel Firima
- Division Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Maseru, Lesotho
- Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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6
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Establishing an Antimicrobial Stewardship Program in Sierra Leone: A Report of the Experience of a Low-Income Country in West Africa. Antibiotics (Basel) 2023; 12:antibiotics12030424. [PMID: 36978291 PMCID: PMC10044650 DOI: 10.3390/antibiotics12030424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/22/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone’s national referral hospital. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic.
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Lakoh S, Yi L, Russell JB, Zhang J, Sevalie S, Zhao Y, Kanu JS, Liu P, Conteh SK, Williams CEE, Barrie U, Sheku MG, Jalloh MB, Adekanmbi O, Jiba DF, Kamara MN, Deen GF, Okeibunor JC, Yendewa GA, Guo X, Firima E. The burden of surgical site infections and related antibiotic resistance in two geographic regions of Sierra Leone: a prospective study. Ther Adv Infect Dis 2022; 9:20499361221135128. [PMID: 36518726 PMCID: PMC9742716 DOI: 10.1177/20499361221135128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/09/2022] [Indexed: 12/13/2022] Open
Abstract
Despite the prolongation of hospitalization, increase in morbidity, mortality and cost of care associated with both surgical site infections (SSIs) and antibiotic resistance, there are limited data on SSIs and antibiotic resistance to guide prevention strategies in Sierra Leone. This study assessed the burden of SSIs and related antibiotic resistance in the 34 Military Hospital (MH) and Makeni Government Hospital (MGH) located in two geographic regions of Sierra Leone using a prospective study design to collect data from adults aged 18 years or older. Of the 417 patients, 233 (55.9%) were enrolled in MGH. Most were women 294 (70.5%). The incidence rate of SSI was 5.5 per 1000 patient-days, and the cumulative incidence of SSI was 8.2%. Common bacteria isolated in MH were Escherichia coli (6,33.3%) and Pseudomonas aeruginosa (3,16.7%) and in MGH were P. aeruginosa (3,42.9%) and Proteus mirabilis (2,28.9%). Of the gram-negative bacteria, 40% were Extended-spectrum beta-lactamase-producing Enterobacteriaceae, 33% were Carbapenem-resistant P. aeruginosa and 10% were carbapenem-resistant Enterobacteriaceae. Although the incidence of SSIs in our study is lower than previously reported, the rate of antibiotic resistance reported in this study is high. Urgent action is needed to invest in the microbiology infrastructure to support SSI surveillance and prevention strategies.
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Affiliation(s)
| | | | - James B.W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Juling Zhang
- Department of Clinical Laboratory, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Sustainable Health Systems Sierra Leone,34 Military Hospital, Freetown, Sierra Leone
| | - Yongkun Zhao
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Peng Liu
- Department of Emergency Medicine, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Sarah K. Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Christine Ellen Elleanor Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone
| | - Mohamed Gbessay Sheku
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Boie Jalloh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,34 Military Hospital, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone,Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA,Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Xuejun Guo
- Tropical Infectious Disease Prevention and Control Center, Freetown, Sierra Leone
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland,SolidarMed, Old Europa, Lesotho,Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
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