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High levels of surgical antibiotic prophylaxis: Implications for hospital-based antibiotic stewardship in Sierra Leone

Published online by Cambridge University Press:  07 July 2022

Sulaiman Lakoh Open the ORCID record for Sulaiman Lakoh [Opens in a new window] ,
Joseph Sam Kanu Open the ORCID record for Joseph Sam Kanu [Opens in a new window] ,
Sarah K. Conteh ,
James B.W. Russell ,
Stephen Sevalie ,
Christine Ellen Elleanor Williams Open the ORCID record for Christine Ellen Elleanor Williams [Opens in a new window] ,
Umu Barrie ,
Aminata Kadie Kabia ,
Fatmata Conteh  and
Mohamed Boie Jalloh
...Show all authors
Sulaiman Lakoh*
Affiliation:
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, Freetown, Sierra Leone Infectious Disease Research Network, Freetown, Sierra Leone
Joseph Sam Kanu
Affiliation:
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
Sarah K. Conteh
Affiliation:
Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
James B.W. Russell
Affiliation:
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
Stephen Sevalie
Affiliation:
College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone Sustainable Health Systems, Freetown, Sierra Leone 34 Military Hospital, Freetown, Sierra Leone
Christine Ellen Elleanor Williams
Affiliation:
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
Affiliation:
Infectious Disease Research Network, Freetown, Sierra Leone
Aminata Kadie Kabia
Affiliation:
34 Military Hospital, Freetown, Sierra Leone
Fatmata Conteh
Affiliation:
Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
Mohamed Boie Jalloh
Affiliation:
College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 34 Military Hospital, Freetown, Sierra Leone
Gibrilla F. Deen
Affiliation:
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
Mustapha S. Kabba
Affiliation:
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
Aiah Lebbie
Affiliation:
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
Ibrahim Franklyn Kamara
Affiliation:
World Health Organization Country Office, Freetown, Sierra Leone
Bobson Derrick Fofanah
Affiliation:
World Health Organization Country Office, Freetown, Sierra Leone
Anna Maruta
Affiliation:
World Health Organization Country Office, Freetown, Sierra Leone
Christiana Kallon
Affiliation:
Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
Foday Sahr
Affiliation:
College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone 34 Military Hospital, Freetown, Sierra Leone
Mohamed Samai
Affiliation:
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
Affiliation:
Department of Medicine, College of Medicine, University of Ibadan, Nigeria Department of Medicine, University College Hospital, Ibadan, Nigeria
Le Yi
Affiliation:
Tropical Disease Prevention and Control Center, Freeown, Sierra Leone
Xuejun Guo
Affiliation:
Tropical Disease Prevention and Control Center, Freeown, Sierra Leone
Rugiatu Z. Kamara
Affiliation:
US Center for Disease Control and Prevention, Freetown, Sierra Leone
Darlinda F. Jiba
Affiliation:
Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
Joseph Chukwudi Okeibunor
Affiliation:
World Health Organization Regional Office for Africa, Brazzaville, Congo
George A. Yendewa
Affiliation:
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
Emmanuel Firima*
Affiliation:
Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland SolidarMed, Maseru West, Lesotho Centre for Multidisciplinary Research and Innovation, Abuja, Nigeria
*
Author for correspondence: Dr. Emmanuel Firima, Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland. E-mail: [email protected]. Or Dr. Sulaiman Lakoh, Department of Medicine, College of Medicine and Allied Health sciences, University of Sierra Leone, FQQ6+3MJ, Freetown, Sierra Leone. E-mail: [email protected]
Author for correspondence: Dr. Emmanuel Firima, Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland. E-mail: [email protected]. Or Dr. Sulaiman Lakoh, Department of Medicine, College of Medicine and Allied Health sciences, University of Sierra Leone, FQQ6+3MJ, Freetown, Sierra Leone. E-mail: [email protected]

Abstract

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Objective:

Despite the impact of inappropriate prescribing on antibiotic resistance, data on surgical antibiotic prophylaxis in sub-Saharan Africa are limited. In this study, we evaluated antibiotic use and consumption in surgical prophylaxis in 4 hospitals located in 2 geographic regions of Sierra Leone.

Methods:

We used a prospective cohort design to collect data from surgical patients aged 18 years or older between February and October 2021. Data were analyzed using Stata version 16 software.

Results:

Of the 753 surgical patients, 439 (58.3%) were females, and 723 (96%) had received at least 1 dose of antibiotics. Only 410 (54.4%) patients had indications for surgical antibiotic prophylaxis consistent with local guidelines. Factors associated with preoperative antibiotic prophylaxis were the type of surgery, wound class, and consistency of surgical antibiotic prophylaxis with local guidelines. Postoperatively, type of surgery, wound class, and consistency of antibiotic use with local guidelines were important factors associated with antibiotic use. Of the 2,482 doses administered, 1,410 (56.8%) were given postoperatively. Preoperative and intraoperative antibiotic use was reported in 645 (26%) and 427 (17.2%) cases, respectively. The most commonly used antibiotic was ceftriaxone 949 (38.2%) with a consumption of 41.6 defined daily doses (DDD) per 100 bed days. Overall, antibiotic consumption was 117.9 DDD per 100 bed days. The Access antibiotics had 72.7 DDD per 100 bed days (61.7%).

Conclusions:

We report a high rate of antibiotic consumption for surgical prophylaxis, most of which was not based on local guidelines. To address this growing threat, urgent action is needed to reduce irrational antibiotic prescribing for surgical prophylaxis.

Type
Original Article
Information
Antimicrobial Stewardship & Healthcare Epidemiology , Volume 2 , Issue 1 , 2022 , e111
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction in any medium, provided the original article is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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