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

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


JournalAntimicrobial Stewardship & Healthcare Epidemiology
Article typeJournal research article – Clinical research
Publication date – Jul – 2022
Authors – Sulaiman Lakoh, Sulaiman Lakoh, Joseph Sam Kanu, Joseph Sam Kanu, Sarah K. Conteh, James B.W. Russell, Stephen Sevalie, Christine Ellen Elleanor Williams, Christine Ellen Elleanor Williams, Umu Barrie, Aminata Kadie Kabia, Fatmata Conteh, Mohamed Boie Jalloh
Keywordsantibiotic consumption, infectious diseases, surgery, surgical antibiotic prophylaxis
Open access – Yes
SpecialitySurgical infection
World region Western Africa
Country: Sierra Leone
Language – English
Submitted to the One Surgery Index on July 30, 2022 at 8:13 pm
Abstract:

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.

OSI Number – 21684

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