Antibiotic prescription patterns in paediatric wards of Rivers State university teaching hospital, southern Nigeria: a point prevalence survey

Antimicrobial resistance remains a threat to patient safety and healthcare outcomes and largely arises from inappropriate antimicrobial prescriptions. This study aimed to determine the pattern of antibiotic prescriptions in the Paediatrics department of Rivers State University Teaching Hospital, Port Harcourt.Method:A point prevalence survey was conducted in the Paediatric wards and Special Care Baby Unit (SCBU) on 13 November 2021. Records of all children admitted before or at 8:00a.m. on the day of the survey were descriptively analysed using the protocol and web-based management system of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp.Results: The antibiotic prevalence in this study was 77.4%. The most common indication(s) for antibiotic use in SCBU was infection prophylaxis (81.3%) and in paediatric wards: Pneumonia, Ear Nose Throat and Soft tissue infections accounted for (23.1%) each. Third-generation cephalosporins and aminoglycosides were predominantly used in all wards and were empirical-based prescriptions. Regarding antibiotic quality indicators of prescriptions: In SCBU: 19 (90.5%) had indication(s) for antibiotics documented, 10 (46.7%) were guideline compliant, and 1 (4.8%) had documented review/stop date. In the paediatric medical and surgical wards, 17(85.0%) vs. 4(100%) had indication(s) for antibiotics documented, 6(30.0%) vs. 0(0%) were guideline compliant, and 1(5.0%) vs. 4(100.0%) had a review/ stop date.Conclusion:High prevalence of antibiotic use, suboptimal antibiotic quality indicators and absence of laboratory evidence for antibiotic prescriptions were observed in the paediatric units. There is a need to reorientate prescribers and institute strategic measures to improve antimicrobial stewardship

Correlation of Nitrite, Leucocyte Esterase and Protein Detection to Diagnosis of Urinary Tract Infections.

Aim: To determine the relationship between detection of nitrite, Leucocyte esterase (LE) and protein in urine and significant bacteriuria. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital, between March and September 2015. Methodology: 240 urine samples were analyzed. Dipstick analysis using Combi-UriScreen 10SL reagent strips (Axiom Medical limited, UK) and culture for significant bacteriuria were performed according to manufacturer’s instruction/ using standard protocols. Data was coded, entered into Microsoft Excel ® version 2010 and analysed using Epi-Info version 7.02. Categorical data were presented as frequencies and percentages using tables. Univariate analysis using logistic regression (Odds Ratio) was used to determine the association between the presence of nitrite, LE and protein and significant bacterial yield in urine. A P-value of ≤ 0.05 was considered statistically significant. Likelihood ratios were calculated. Results: 23 (23.2%) out of 99 samples with significant bacteriuria were nitrite positive, while 42 (42.4%) and 45 (45.5%) were positive for leucocyte esterase and protein respectively. Nitrite (P = 0.001, OR = 5.03, 95% CI = 2.02-12.93) and leucocyte esterase positivity (P = 0.001, OR = 3.59, 95% CI = 1.91-6.80) were significantly associated with significant bacteriuria while proteinuria was not (P = 0.989, OR = 1.03, 95% CI = 0.60-1.79). Nitrite positivity alone had the best positive likelihood ratio (4.09, 95% CI: 1.91, 8.78) followed by the combination of nitrite and LE positivity (3.65, 95% CI: 1.90, 7.03). Conclusion: The use of dipstick analysis of urine as a screening tool for samples to be cultured may be a very effective way of reducing laboratory costs and wastage of man hours, which both ultimately improve the effectiveness of clinical laboratories especially in resource-poor settings.