Management of infections in sickle cell patients under 14 years at Komfo Anokye Teaching Hospital

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JULY, 2016
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Background: Sickle cell disease affects millions of people across the globe. Microbial infections are common causes of sickle cell crises and mortality. Penicillin Prophylaxis has been used to prevent infections in sickle cell disease; however there have been reports of increased prevalence of resistant strains of streptococcus pneumonia against penicillins, which is one of the main causative organisms for infections in sickle disease patients. The aim of this study was to assess the pattern of microbial infections and antibiotic usage in sickle cell patients, and its impact on patient outcomes. Methodology: This was a retrospective study undertaken at KATH in sickle cell disease patients under 14 years. Past records of the patients (N=253) who had been on admission for an infection between the periods of December 2011 to December 2014 were reviewed. Data was extracted on the diagnosis, drug history, laboratory results, drug administration and discharge summary which had been recorded in the patient folders. Data on therapy obtained was assessed for its appropriateness using recommendations in the Standard Treatment Guidelines (2010) and other international guidelines like the World Health Organization guidelines for the management of sickle cell disease. These guidelines been adapted by the clinicians at the Sickle Cell Unit, at KATH. Results: More than 69% (n=157) of infection diagnosis in the sickle cell patients was informed by results of haematology investigations, 6.19% (n=14) were diagnosed based on microbiology data and 24.34% (n=55) were both haematology and microbiology. As a complication of sickle cell disease a quarter of the study population (n=62) were admitted with bronchopneumonia infection, 16.60% (n=42) had sepsis, 16.21 %( n=41) had acute chest syndrome and 12.25 %( n=31) had osteomyelitis. Cefuroxime was the most prescribed antibiotic 71.15 %( n=180) followed by clindamycin 8.3% (n=20) and ciprofloxacin 6.3 %( n=16). Over 90% of the antibiotics were administered through the intravenous route (n=249). Also more than 80% of the patients were on Penicillin Prophylaxis (n=207). Few (n=2) were on other antibiotics for prophylaxis such as erythromycin. Based on the standard guidelines, All the patients (n=253) had the dosing frequency of antibiotic therapy correct; 94.07 %( n=238) were given the appropriate antibiotic, 90.91% (n=230) had the duration of therapy correct and 87.35% (n=221) had the dose also appropriate. Eighty nine percent of the patients had their symptoms resolved on antibiotic therapy before discharge, whilst 11% still had symptoms. Patient on Penicillin Prophylaxis presented with the same infectious diseases as those not on Penicillin Prophylaxis. Conclusion: Bronchopneumonia, Sepsis, Acute Chest Syndrome and Osteomyelitis were the most common infections reported in the sickle cell disease patients. Cefuroxime, Clindamycin and Ciprofloxacin were the most frequently used antibiotics. Most of the investigations that guided infection diagnosis were haematological rather than microbiology (culture and sensitivity testing). It is recommended that as much as possible, antibiotics usage in sickle cell disease patients must be guided by culture and sensitivity testing for more definitive therapy. Such a practice may minimise the risk and the occurrence of antimicrobial resistance among pathogens responsible for infections in sickle cell disease patients.
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,