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Abiri OT, Ninka A, Coker J, Thomas F, Smalle IO, Lakoh S, Turay FU, Komeh J, Sesay M, Kanu JS, Mustapha AM, Bell NVT, Conteh TA, Conteh SK, Jalloh AA, Russell JBW, Sesay N, Bawoh M, Samai M, Lahai M. An Assessment of Medication Errors Among Pediatric Patients in Three Hospitals in Freetown Sierra Leone: Findings and Implications for a Low-Income Country. Pediatric Health Med Ther 2024; 15:145-158. [PMID: 38567243 PMCID: PMC10986401 DOI: 10.2147/phmt.s451453] [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: 11/25/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Background Pediatric patients are prone to medicine-related problems like medication errors (MEs), which can potentially cause harm. Yet, this has not been studied in this population in Sierra Leone. Therefore, this study investigated the prevalence and nature of MEs, including potential drug-drug interactions (pDDIs), in pediatric patients. Methods The study was conducted in three hospitals among pediatric patients in Freetown and consisted of two phases. Phase one was a cross-sectional retrospective review of prescriptions for completeness and accuracy based on the global accuracy score against standard prescription writing guidelines. Phase two was a point prevalence inpatient chart review of MEs categorized into prescription, administration, and dispensing errors and pDDIs. Data was analyzed using frequency, percentages, median, and interquartile range. Kruskal-Wallis H and Mann-Whitney U-tests were used to compare the prescription accuracy between the hospitals, with p<0.05 considered statistically significant. Results Three hundred and sixty-six (366) pediatric prescriptions and 132 inpatient charts were reviewed in phases one and two of the study, respectively. In phase one, while no prescription attained the global accuracy score (GAS) gold standard of 100%, 106 (29.0%) achieved the 80-100% mark. The patient 63 (17.2%), treatment 228 (62.3%), and prescriber 33 (9.0%) identifiers achieved an overall GAS range of 80-100%. Although the total GAS was not statistically significant (p=0.065), the date (p=0.041), patient (p=<0.001), treatment (p=0.022), and prescriber (p=<0.001) identifiers were statistically significant across the different hospitals. For phase two, the prevalence of MEs was 74 (56.1%), while that of pDDIs was 54 (40.9%). There was a statistically positive correlation between the occurrence of pDDI and number of medicines prescribed (r=0.211, P=0.015). Conclusion A Low GAS indicates poor compliance with prescription writing guidelines and high prescription errors. Medication errors were observed at each phase of the medication use cycle, while clinically significant pDDIs were also reported. Thus, there is a need for training on prescription writing guidelines and medication errors.
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Affiliation(s)
- Onome T Abiri
- Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Alex Ninka
- Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joshua Coker
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Fawzi Thomas
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmaceutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Isaac O Smalle
- Department of Surgery, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Foday Umaro Turay
- Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James Komeh
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Sesay
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- Department of Community Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ayeshatu M Mustapha
- Department of Pediatrics, Ola During Children Hospital, Freetown, Sierra Leone
| | - Nellie V T Bell
- Department of Pediatrics, Ola During Children Hospital, Freetown, Sierra Leone
| | - Thomas Ansumus Conteh
- Department of Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Department of Pharmaceutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sarah Kadijatu Conteh
- Department of Pediatrics, King Harman Road Maternity and Children Hospital, Freetown, Sierra Leone
| | - Alhaji Alusine Jalloh
- Department of Pediatrics, King Harman Road Maternity and Children Hospital, Freetown, Sierra Leone
| | - James B W Russell
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Noah Sesay
- Department of Clinical Pharmacy and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Bawoh
- Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mohamed Samai
- Department of Pharmacology and Therapeutics, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Michael Lahai
- Department of Pharmaceutical Chemistry, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Berhe DF, Beyene GT, Seyoum B, Gebre M, Haile K, Tsegaye M, Boltena MT, Tesema E, Kibret TC, Biru M, Siraj DS, Shirley D, Howe R, Abdissa A. Prevalence of antimicrobial resistance and its clinical implications in Ethiopia: a systematic review. Antimicrob Resist Infect Control 2021; 10:168. [PMID: 34861894 PMCID: PMC8642948 DOI: 10.1186/s13756-021-00965-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is one of the major public health challenges in Ethiopia. However, there is no comprehensive summary of existing AMR data in the country. AIM To determine the prevalence of antimicrobial resistance and its clinical implications in Ethiopia. METHODS A systematic literature search was performed on the PubMed/Medline database. Original studies on antimicrobial resistance conducted in Ethiopia between 1st January 2009 and 31st July 2019 were included. The outcome measure was the number of isolates resistant to antimicrobial agents in terms of specific pathogens, and disease condition. Data was calculated as total number of resistant isolates relative to the total number of isolates per specific pathogen and medication. RESULTS A total of 48,021 study participants enrolled from 131 original studies were included resulting in 15,845 isolates tested for antimicrobial resistance. The most common clinical sample sources were urine (28%), ear, nose, and throat discharge collectively (27%), and blood (21%). All the studies were cross-sectional and 83% were conducted in hospital settings. Among Gram-positive bacteria, the reported level of resistance to vancomycin ranged from 8% (Enterococcus species) to 20% (S. aureus). E. coli, K. pneumoniae and P. aeruginosa were the most common Gram-negative pathogens resistant to key antimicrobial agents described in the national standard treatment guideline and were associated with diverse clinical conditions: urinary tract infections, diarrhea, surgical site infections, pneumonia, ocular infections, and middle ear infections. CONCLUSION Overall, there is a high prevalence of antimicrobial resistance in Ethiopia. Empirical treatment of bacterial infections needs to be guided by up-to-date national guidelines considering local antimicrobial susceptibility patterns. Equipping diagnostic laboratories with culture and drug susceptibility testing facilities, and establishing a strong antimicrobial stewardship program should be high priorities.
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Affiliation(s)
- Derbew Fikadu Berhe
- College of Health Sciences, School of Pharmacy, Mekelle University, Mekelle, Ethiopia
| | | | - Berhanu Seyoum
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia.
| | - Meseret Gebre
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia
| | - Kassa Haile
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia
| | - Mulugeta Tsegaye
- Department of Internal Medicine, ALERT Hospital, Addis Ababa, Ethiopia
| | | | - Emawayish Tesema
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia
| | | | - Mulatu Biru
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia
| | - Dawd S Siraj
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin- Madison, Madison, USA
| | - Daniel Shirley
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin- Madison, Madison, USA
| | - Rawleigh Howe
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia
| | - Alemseged Abdissa
- Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia
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Craft KM, Gaddy JA, Townsend SD. Human Milk Oligosaccharides (HMOs) Sensitize Group B Streptococcus to Clindamycin, Erythromycin, Gentamicin, and Minocycline on a Strain Specific Basis. ACS Chem Biol 2018; 13:2020-2026. [PMID: 30071726 DOI: 10.1021/acschembio.8b00661] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human milk oligosaccharides (HMOs) possess antimicrobial and antibiofilm activity against Group B Streptococcus (GBS). HMOs were screened for their ability to potentiate antibiotic activity. We observed that HMOs potentiate the function of aminoglycosides, lincosamides, macrolides, and tetracyclines on a strain specific basis but not β-lactams or glycopeptides that inhibit cell wall synthesis. These findings are notable as GBS has evolved high levels of resistance toward aminoglycosides, macrolides, and tetracyclines. Finally, HMOs potentiate the function of aminoglycosides against both Staphylococcus aureus and Acinetobacter baumannii. On the basis of these observations, we hypothesized that HMOs act by increasing membrane permeability. This hypothesis was evaluated using a bacterial membrane permeability assay which revealed that HMOs increase membrane permeability toward propidium iodide.
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Affiliation(s)
- Kelly M. Craft
- Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Nashville, Tennessee 37235, United States
| | - Jennifer A. Gaddy
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, D-3100 Medical Center North, Nashville, Tennessee 37232, United States
- Tennessee Valley Healthcare Systems, Department of Veterans Affairs, 1310 24th Avenue South, Nashville, Tennessee 37212, United States
| | - Steven D. Townsend
- Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Nashville, Tennessee 37235, United States
- Vanderbilt Institute of Chemical Biology, Vanderbilt University, 896 Preston Research Building, Nashville, Tennessee 37232, United States
- Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University, Medical Center North A-5302, 1161 21st Ave South, Nashville, Tennessee 37232, United States
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Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker JN. Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children. Paediatr Int Child Health 2018; 38:S3-S15. [PMID: 29790842 PMCID: PMC6176768 DOI: 10.1080/20469047.2017.1408738] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Guidelines from 2005 for treating suspected sepsis in low- and middle-income countries (LMIC) recommended hospitalisation and prophylactic intramuscular (IM) or intravenous (IV) ampicillin and gentamicin. In 2015, recommendations when referral to hospital is not possible suggest the administration of IM gentamicin and oral amoxicillin. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for treating sepsis (taking into account susceptibility patterns, cost and risk of adverse events) in neonates and children is necessary. Methods Systematic literature review and international guidelines were used to identify published evidence regarding the treatment of (suspected) sepsis. Results Five adequately designed and powered studies comparing antibiotic treatments in a low-risk community in neonates and young infants in LMIC were identified. These addressed potential simplifications of the current WHO treatment of reference, for infants for whom admission to inpatient care was not possible. Research is lacking regarding the treatment of suspected sepsis in neonates and children with hospital-acquired sepsis, despite rising antimicrobial resistance rates worldwide. Conclusions Current WHO guidelines supporting the use of gentamicin and penicillin for hospital-based patients or gentamicin (IM) and amoxicillin (oral) when referral to a hospital is not possible are in accordance with currently available evidence and other international guidelines, and there is no strong evidence to change this. The benefit of a cephalosporin alone or in combination as a second-line therapy in regions with known high rates of non-susceptibility is not well established. Further research into hospital-acquired sepsis in neonates and children is required.
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Affiliation(s)
- Aline Fuchs
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Corresponding author.
| | - Julia Bielicki
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Shrey Mathur
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Johannes N. Van Den Anker
- Paediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland,Division of Clinical Pharmacology, Children’s National Health System, Washington, DC, USA
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Shahid ASMSB, Ahmed T, Shahunja KM, Kabir S, Chowdhury F, Faruque ASG, Das SK, Sarker MHR, Bardhan PK, Chisti MJ. Factors Associated with Streptococcal Bacteremia in Diarrheal Children under Five Years of Age and Their Outcome in an Urban Hospital in Bangladesh. PLoS One 2016; 11:e0154777. [PMID: 27135829 PMCID: PMC4852900 DOI: 10.1371/journal.pone.0154777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 04/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although Streptococcal bacteremia is common in diarrheal children with high morbidity and mortality, no systematic data are available on Streptococcal bacteremia in diarrheal children. We sought to evaluate the factors associated with Streptococcal bacteremia in diarrheal children under five years of age and their outcome. Methods We used an unmatched case-control design to investigate the associated factors with Streptococcal bacteremia in all the diarrheal children under five years of age through electronic medical record system of Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. We had simultaneously used a retrospective cohort design to further evaluate the outcome of our study children. All the enrolled children had their blood culture done between January 2010 and December 2012. Comparison was made among the children with (cases = 26) and without Streptococcal bacteremia (controls = 78). Controls were selected randomly from hospitalized diarrheal children under five years of age. Results Cases had proportionately higher deaths compared to controls, but it was statistically insignificant (15% vs. 10%, p = 0.49). The cases more often presented with severe dehydration, fever, respiratory distress, severe sepsis, and abnormal mental status compared to the controls (for all p<0.05). In the logistic regression analysis, after adjusting for potential confounders, it has been found that Streptococcal bacteremia in diarrheal children under five years of age was independently associated with nutritional edema (OR: 5.86, 95% CI = 1.28–26.80), hypoxemia (OR: 19.39, 95% CI = 2.14–175.91), fever (OR: 4.44, 95% CI = 1.13–17.42), delayed capillary refill time (OR: 7.00, 95% CI = 1.36–35.93), and respiratory distress (OR: 2.69, 95% CI = 1.02–7.12). Conclusions and Significance The results of our analyses suggest that diarrheal children under five years of age presenting with nutritional edema, hypoxemia, fever, delayed capillary refill time, and respiratory distress may be at risk of Streptococcal bacteremia. It underscores the importance of identification of these simple clinical parameters for the prompt recognition and management in order to reduce the morbidity and death of such children especially in resource limited settings.
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Affiliation(s)
| | - Tahmeed Ahmed
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Shahunja
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Senjuti Kabir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syeed Golam Faruque
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Habibur Rahman Sarker
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Prevalence, clinical features, and outcome of pseudomonas bacteremia in under-five diarrheal children in bangladesh. ISRN MICROBIOLOGY 2014; 2014:469758. [PMID: 24734204 PMCID: PMC3966484 DOI: 10.1155/2014/469758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/18/2022]
Abstract
We sought to evaluate the prevalence, associated factors, and outcome of under-five diarrheal children with either sex having Pseudomonas bacteremia. A retrospective chart review of under-five diarrheal children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 2011 to December 2011 was performed using an online hospital management system. Children with Pseudomonas bacteremia constituted the cases (n = 31), and the controls (n = 124), without Pseudomonas bacteremia, were randomly selected. The prevalence of Pseudomonas bacteremia was 1% (31/5,179). The Pseudomonas was multidrug resistant but was 84% sensitive to ceftazidime and 100% to imipenem. The case-fatality rate was significantly higher among the cases than the controls (26% versus 5%; P = 0.003). In logistic regression analysis, after adjusting for potential confounders such as severe wasting, severe underweight, severe pneumonia, and young age (11.71 (4.0, 18.0) months), the cases more often presented with absent peripheral pulses in absence of dehydration (95% CI = 2.31–24.45) on admission. This finding underscores the importance of early identification of this simple clinical sign to ensure prompt management including fluid resuscitation and broad spectrum antibiotics to help reduce morbidity and mortality in such children, especially in resource-poor settings.
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