Antibiotic use and resistance in single orthopedic department, Egypt

ABSTRACT

Antimicrobial use and subsequently antimicrobial resistance among bacterial pathogens is a global problem, but in Egypt data are sparse. Orthopedic departments reflect this problem because in them surgery constitutes the main manipulation and septic diseases constitute common complications, both need guided antimicrobial therapy otherwise antimicrobial resistance will emerge. To highlight these issues, we define the pattern and appropriateness of antibiotic use and identify the infecting microorganisms and their resistance patterns in a prospective study carried out in Orthopedic Department, Tanta University Hospital, Egypt, within 9 months. High antimicrobial prescription rates [98.1%] with low rates of appropriateness [11.3%] were detected. Eighty-one percent of prescribed antimicrobial agents belong to cephalosporins and penicillins classes and 54.2% of all antimicrobial use consisted of cefotaxime [42.1%] and amoxicillin-flucloxacillin [12.1%]. High rates of resistance were found in most of the bacteria studied. 53.3% of Staphylococcus aureus [S. aureus] and 66.7% of coagulase negative staphylococcus [CNS] isolates were oxacillin resistant. Multi-resistant [MR] strains represented 48.6% of the isolated gram negative bacilli of which 29.2% were ESBL [Klebsiella 62.5% and E.coli 33.3%] while 19.4% were MR Pseudomonas and Acinetobacter isolates. Antibiotic treatment in our Orthopedic Department appears to be substantial. Increasing and justifying efforts are needed to improve appropriateness of antimicrobial therapy and minimize the development of antimicrobial resistance. We call for a nationwide surveillance programme to monitor microbial trends and antimicrobial resistance patterns in Egypt