ABSTRACT
Background: The inappropriate use of antibiotics results in the emergence of antimicrobial resistance and adverse clinical and economic outcomes in hospital in-patients. A lack of institutional and national antibiotic guidelines promotes inappropriate antibiotic use. The objectives of this study are to evaluate the appropriateness of antibiotic prescribing, and the quality of antibiotic use in medical wards of the Lagos University Teaching Hospital, Lagos, Nigeria. Methodology: This was a descriptive cross-sectional study of patients admitted and placed on antibiotics in the medical wards of Lagos University Teaching Hospital between July 2013 and August 2014. The appropriateness of antibiotic therapy was determined by compliance with the guidelines of the Infectious Diseases Society of America (IDSA). Results: A total of 350 hospitalized patients on antibiotic therapy during the period of the study were reviewed, including 197 (56.3%) males and 153 females (43.7%). The mean age of the patients was 48.7±17.6 years and a total of 539 initial antibiotics were empirically prescribed. Antibiotic therapy was considered inappropriate in 290 (82.9%) patients, of which 131 (37.4%) patients had no evidence of infection. Pneumonia (23.1%) was the most common indication for antibiotic use, out of which 59.3% had inappropriate antibiotic therapy. Overall, the most frequently prescribed initial empirical antibiotic classes were imidazole derivatives (32.4%) and cephalosporins (22.0%), while the most frequently prescribed inappropriate antibiotic classes were carbapenems (100.0%) and quinolones (89.3%). Conclusion: The study revealed a high rate of inappropriate antibiotic therapy. There is an imperative need to establish antimicrobial stewardship programmes to curb the inappropriate use of antibiotics in the hospital.
Subject(s)
Male , Female , Drug Prescriptions , Drug Resistance, Microbial , Drug Overdose , Anti-Bacterial AgentsABSTRACT
AIMS AND OBJECTIVES: Carbapenemase production among clinical isolates of Enterobacteriaceae has been widely reported with prevalence rates ranging from between 2.8% and 53.6%. The aim of this study was to assess the prevalence of carbapenemase production among clinical isolates of Enterobacteriaceae from a Tertiary Hospital in Lagos, Nigeria, and to characterize the type of carbapenemase produced. MATERIALS AND METHODS: Carbapenemase production was detected phenotypically using a commercially available combination disc test (Rosco Diagnostica carbapenemase detection Neo-Sensitab) containing inhibitors to the various carbapenemase classes. The Neo-Sensitabs were used for Enterobacteriaceae isolates that were resistant after the initial antibiotic susceptibility testing with meropenem (10 µg). RESULTS: A total of 177 Enterobacteriaceae isolates were investigated and 27 (15.2%) were carbapenem-resistant. From the 27 carbapenem non-susceptible isolates, 22 (12.4%) were carbapenemase producers while 5 (2.8%) exhibited carbapenem resistance due to extended spectrum beta-lactamase production. Of the 22 isolates that were positive for carbapenemase production, 15 (8.5%) were metallo beta-lactamase (MBL) producers, 6 (3.4%) produced oxacillinase-48 while 1 (0.5%) produced both MBL and Klebsiella pneumoniae carbapenemase. Hence, the overall prevalence of carbapenemase-producing Enterobacteriaceae in this study was 12.4%. CONCLUSION: Carbapenemase-producing Enterobacteriaceae was indeed prevalent in our institution. The combination disc test was a cost effective and suitable method for the initial detection of carbapenemase-producing Enterobacteriaceae within the clinical setting especially when molecular detection methods are not available.
