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

Sulaiman Lakoh, Olukemi Adekanmbi, Darlinda F. Jiba, Gibrilla F. Deen, Wadzani Gashau, Stephen Sevalie, Eili Y. Klein

Research output: Contribution to journalArticle

Abstract

Objectives: 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. Design: A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)71-76
Number of pages6
JournalInternational Journal of Infectious Diseases
Volume90
DOIs
StatePublished - Jan 2020

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Sierra Leone
Anti-Bacterial Agents
Inpatients
Imidazoles
Cephalosporins
Microbial Drug Resistance
Leukocyte Count
Tertiary Care Centers
Penicillins
Developing Countries
Pneumonia
Fever
Cross-Sectional Studies
Wounds and Injuries
Population

Keywords

  • Antibiotic resistance
  • Antimicrobial stewardship
  • Laboratory

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Antibiotic use among hospitalized adult patients in a setting with limited laboratory infrastructure in Freetown Sierra Leone, 2017–2018. / Lakoh, Sulaiman; Adekanmbi, Olukemi; Jiba, Darlinda F.; Deen, Gibrilla F.; Gashau, Wadzani; Sevalie, Stephen; Klein, Eili Y.

In: International Journal of Infectious Diseases, Vol. 90, 01.2020, p. 71-76.

Research output: Contribution to journalArticle

Lakoh, Sulaiman ; Adekanmbi, Olukemi ; Jiba, Darlinda F. ; Deen, Gibrilla F. ; Gashau, Wadzani ; Sevalie, Stephen ; Klein, Eili Y. / Antibiotic use among hospitalized adult patients in a setting with limited laboratory infrastructure in Freetown Sierra Leone, 2017–2018. In: International Journal of Infectious Diseases. 2020 ; Vol. 90. pp. 71-76.
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abstract = "Objectives: 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. Design: A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. Results: 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. Conclusion: 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.",
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