Antibacterial use and resistance pattern at the accident and emergency department of Komfo Anokye Teaching Hospital

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March, 2015
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Background and Objectives: Antimicrobial resistance is a major problem all over the world due to indiscriminate and inappropriate use of antimicrobials both in healthcare facilities and in communities. The Accident and Emergency Department (AED) serves as a major area where antimicrobial therapy is initiated for severe infections but data on use of antimicrobial agents in these setting are lacking in Africa. This study aim was to determine the appropriateness of antibacterial use as well as antibacterial resistance patterns of commonly isolated bacteria at AED of Komfo Anokye Teaching Hospital (KATH). Methodology: This was prospective observational study undertaken from 1st March to 30th April, 2014. Two hundred and eighty-two patients at the AED wards were selected by systematic random sampling from 1119 patients exposed to antibacterials out of total 1942 admitted within the study period. These patients were then followed on daily for data on antibacterial use. From 85 of the admitted patients, 90 specimens were taken for culture and sensitivity testing at the Medical Microbiology laboratory of KATH. The specimens included blood (n=37), others such as ascitic fluid, pleural fluid and knee joint aspirate (n=28), urine (n=15), cerebrospinal fluid (n=5) and wound swab (n=5). Appropriateness of antibacterial use was assessed based on recommendations in the Standard Treatment Guidelines-2010 of Ghana and other international standard guidelines accepted globally and adapted by clinicians at KATH. Results: In all 1119 out of 1942 patients encountered within the study period were prescribed antibacterials, representing a prevalence of 57.6%. Of the 282 sampled, 61.7% (n=174) were on curative antibacterial therapy and 38.3% (n=108) were on prophylactic therapy. Cefuroxime was vi the most prescribed antibacterial agent (DDD/100days: parenteral 36.119; oral 75.850) and Doxycycline (DDD/100days: oral 16.689) was the least prescribed. Seventy percent (n=196) of antibacterial prescriptions were considered appropriate based on recommendations in the approved standard guidelines. For those patients on curative antibacterial therapy who were followed (n=123), 15.4% (n=19) died, 56.1% (n=69) had improvement in their clinical status and general well-being, and 28.5% (n=35) had their symptoms worsening. Twenty-six percent (n=23) of the 90 specimens recorded bacterial growth. The most common isolates were E. coli (n=10), Coagulase Negative Staphylococcus (n=6, possibly contaminants of blood and ascitic fluid specimens), Klebsiella spp (n=4), Pseudomonas spp (n=2) and MRSA (n=1). Over 70% of the E. coli isolates tested were resistant to ceftriaxone, cefuroxime, ciprofloxacin and cotrimoxazole. The Klebsiella isolates were resistant to cefuroxime, cotrimoxazole and ceftriaxone. Conclusion: The rate of antibacterial prescribing at AED was high, with a third of the prescriptions considered inappropriate. Klebsiella and E coli isolates from patient samples sent to the laboratory were resistant to broad spectrum antibacterial agents like ceftriaxone and cefuroxime. Antimicrobial agents should therefore be used more responsibly, guided by culture and sensitivity data for definitive therapy. This would minimize morbidity and mortality from infectious diseases as well as the risk of emergence and spread of antimicrobial resistance in hospitals.
A thesis submitted to the Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, in partial fulfillment of the requirements for the Award of Master of Science in Clinical Pharmacy