Point Prevalence Survey of Antimicrobial Prescription and Consumption in a Nigerian Tertiary Hospital: A Gateway to the Antimicrobial Stewardship Program.

BACKGROUND: Antimicrobial stewardship is an important action plan for curbing the rising trend of antimicrobial resistance (AMR). Surveillance of antimicrobial use and consumption is needed as baseline data and for monitoring the impact of antimicrobial stewardship interventions. The survey was done to understand the burden of AMR, in view of establishing an antimicrobial stewardship program in our hospital. METHODS: A point prevalence survey (PPS) of antimicrobial use and consumption was conducted on all inpatients admitted before 8.00 am on the days of the survey using a standardized questionnaire. The collected data were entered online into the Global PPS web-based application (www.global-pps.com), for analysis. RESULT: Of the 178 patients admitted during the survey period, 50.6% were on one or more antimicrobial agents. All the patients in adult intensive care units were on antibiotics (100%), followed by neonatal intensive care units (83.3%), with the least being adult medical wards (39.4%). Beta-lactam antibiotics were the most frequently prescribed antimicrobial for various infections, especially skin and soft tissue infections, 41.3%, which were the most common diagnoses treated with antibiotics. The infection was mostly community-acquired (81.6%), of which 94.9% were treated empirically. There was no written guideline in existence. CONCLUSION: The present study revealed a poor prescribing habit because of a high rate of empirical treatment. The need for antimicrobial stewardship cannot be overemphasized as it will help streamline and improve the prescribing pattern.

Longitudinal changes in energy expenditure and body composition in obese women with normal and impaired glucose tolerance.

Our primary objective was to evaluate changes in energy expenditure and body composition in women with normal glucose tolerance (NGT) and gestational diabetes mellitus (GDM). A secondary objective was to examine the relationship between maternal leptin and nutrient metabolism. Fifteen obese women, eight with NGT and seven with GDM, were evaluated before conception (P), at 12-14 wk (E), and at 34-36 wk (L). Energy expenditure and glucose and fat metabolism were measured using indirect calorimetry. Basal hepatic glucose production was measured using [6,6-2H2]glucose and insulin sensitivity by euglycemic clamp. There was a significant increase (6.6 kg, P = 0.0001) in fat mass from P to L. There was a 30% (P = 0.0001) increase in basal O2 consumption (VO2, ml/min). There were no significant changes in carbohydrate oxidation during fasting or storage from P to L. There was, however, a significant (P = 0.0001) 150% increase in basal fat oxidation (mg/min) from P to L. Under hyperinsulinemic conditions, there were similar 25% increases in VO2 (P = 0.0001) from P to L in both groups. Because of the significant increases in insulin resistance from P to L, there was a significant (P = 0.0001) decrease in carbohydrate oxidation and storage. There was a net change from lipogenesis to lipolysis, i.e., fat oxidation (30-40 mg/min, P = 0.0001) from P to L. Serum leptin concentrations had a significant positive correlation with fat oxidation at E (r = 0.76, P = 0.005) and L (r = 0.72, P = 0.009). Pregnancy in obese women is associated with significant increases in fat mass and basal metabolic rate and an increased reliance on lipids both in the basal state and during the clamp. These modifications are similar in women with NGT and GDM. The increased reliance on fat metabolism is accompanied by a concomitant decrease in carbohydrate metabolism during hyperinsulinemia. The increase in fat oxidation may be related to increased maternal serum leptin.

The effect of gender and gestational diabetes mellitus on cord leptin concentration.

OBJECTIVE: The purpose of this study was to determine the relationship of neonatal sex and gestational diabetes mellitus on cord leptin concentration and to determine whether cord leptin has a stronger correlation with fat mass compared with birth weight or lean body mass. We hypothesized that there are no significant differences in fetal leptin concentration between male and female or between neonates of mothers with gestational diabetes mellitus and control neonates, when adjusted for body composition. STUDY DESIGN: Cord blood leptin concentrations were measured in newborn infants of 78 women (44 control neonates and 34 gestational diabetes mellitus). Of the 78 neonates, 32 babies were female, and 46 babies were male. Birth weights were measured with a calibrated scale, and body compositions were measured by total body electrical conductivity. RESULTS: Estimated mean gestational age at delivery was 39.1 +/- 1.1 weeks for control neonates versus 38.6 +/- 1.3 weeks for neonates of mothers with gestational diabetes mellitus (P =.01). The fat mass for the control neonates and neonates of mothers with gestational diabetes mellitus was 0.36 +/- 0.15 kg versus 0.48 +/- 0.21 kg (P =.01); the percent body fat for the control neonates and neonates of mothers with gestational diabetes mellitus was 10.5% +/- 3.8% versus 13.2% +/- 4.3% (P =.006), respectively. There was no significant difference in cord leptin concentration between male and female neonates (16.0 +/- 13.8 ng/dL vs 12.7 +/- 12.8 ng/dL, P =.24). Cord leptin concentrations (18.1 +/- 16.2 ng/dL vs 10.9 +/- 9.5 ng/dL, P =.02) were significantly greater in neonates of mothers with gestational diabetes mellitus than in control neonates. In all subjects, cord leptin was significantly correlated with percent body fat (r = 0.51, P <.0001), fat mass (r = 0.49,P <.0001), and birth weight (r = 0.25, P =.03). After the adjustment for fat mass, there was no significant difference in cord leptin concentration between control neonates and neonates of mothers with gestational diabetes mellitus (P =.20), but there was a significant difference between male and female neonates (P =.04). However, when an adjustment was made for both fat mass and lean body mass, there was no longer a significant difference between male and female neonates (P =.12) CONCLUSION: The differences in cord leptin concentration between male and female neonates and between infants of women with gestational diabetes mellitus and control neonates are related to differences in body composition.