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1. Mortality associated with third-generation cephalosporin resistance in Enterobacterales bloodstream infections at eight sub-Saharan African hospitals (MBIRA): a prospective cohort study

Author

Aliye, Jabir, Assefa, Nega, Edessa, Dumessa, Oundo, Joseph, Berihun, Mulu, Dankwah, Thomas, Osei, Mary M, Fandoh, Maud, Gakpo, Margaret, Mulunda, Caroline, Mvera, Benedict, Chimenya, Mabvuto, Feasey, Nicholas, Mallewa, Jane, Abdulraheem, Khadija, Akujobi, Tobechi A, Okonkwo, Chinelo H, Britz, Luzell, Bulbula, André N H, Fataar, Aaqilah, Mmbaga, Blandina T, Ng'unda, Neema, Chirwa, Uchizi, Kakula, Nyambe, Mutemba, Charles, Nakazwe, Ruth, Aiken, Alexander M, Rehman, Andrea M, de Kraker, Marlieke E A, Madrid, Lola, Kebede, Meron, Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Nyamwaya, Brian, Kagucia, Eunice, Cocker, Derek, Kawaza, Kondwani, Lester, Rebecca, Iregbu, Kenneth C, Medugu, Nubwa, Nwajiobi-Princewill, Philip I, Dramowski, Angela, Sonda, Tolbert, Hemed, Asia, Fwoloshi, Sombo, Ojok, David, Scott, J Anthony G, and Whitelaw, Andrew

Published
2023
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3. Extended-spectrum beta-lactamases in clinical isolates of Escherichia coli and Klebsiella pneumoniae recovered from patients at the Tamale Teaching Hospital, Ghana.

Author

Tetteh, Francis Kwame Morgan, Ablordey, Anthony, Obeng-Nkrumah, Noah, and Opintan, Japheth Awuletey

Subjects
KLEBSIELLA pneumoniae, ESCHERICHIA coli, TEACHING hospitals, FOSFOMYCIN, CONVENIENCE sampling (Statistics), MICROBIAL sensitivity tests
Abstract

Introduction: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are pathogens of significant public health interest for which new antibiotics are urgently needed. Aim: To determine the prevalence of ESBLs in E. coli and K. pneumoniae isolates from patients attending the Tamale Teaching Hospital (TTH) in Ghana. Methodology: The study was a cross-sectional study involving convenience sampling of E. coli and K. pneumoniae isolates from consenting patients' clinical specimens, between April and June 2015. Antimicrobial susceptibility test was performed, and ESBL-producer phenotypes were further screened for BlaTEM, BlaSHV, and BlaCTX-M genes. Patients' clinical data were additionally collected using a structured questionnaire. Results: Of the 150 non-duplicate E. coli and K. pneumoniae isolates identified, 140 were confirmed as E. coli (84%, n = 117) and K. pneumoniae (16%, n = 23). Of these, sixty-two (44%) [E. coli (84%; n = 52); K. pneumoniae (16%; n = 10)] phenotypically expressed ESBLs. The proportion of ESBL-producing isolates was higher in adults (15–65 years) than in neonates (< 28 days) (p = 0.14). Most of the isolates showed a high percentage resistance to ampicillin (96%) and tetracycline (89%), but a relatively lower resistance to amikacin (36%). No isolate was resistant to meropenem. More ESBL producers were multidrug resistant compared to non-ESBL-producers [23% (14/62) versus 18% (14/78); p = 0.573]. Overall, 74% (n = 46) of the ESBL genotypes expressed BlaCTX-M-1 genes, followed by 63% (n = 39) BlaTEM, and 16% (n = 10) BlaSHV. The study showed a high prevalence of ESBL-positive E. coli and K. pneumoniae, mostly CTX-M-1 producers at TTH. Conclusion: Routine laboratory ESBL screening is warranted to inform patient management. [ABSTRACT FROM AUTHOR]

Published
2024
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5. Mortality associated with third-generation cephalosporin resistance in Enterobacterales bloodstream infections at eight sub-Saharan African hospitals (MBIRA): a prospective cohort study

Author

Aiken, Alexander M, primary, Rehman, Andrea M, additional, de Kraker, Marlieke E A, additional, Madrid, Lola, additional, Kebede, Meron, additional, Labi, Appiah-Korang, additional, Obeng-Nkrumah, Noah, additional, Nyamwaya, Brian, additional, Kagucia, Eunice, additional, Cocker, Derek, additional, Kawaza, Kondwani, additional, Lester, Rebecca, additional, Iregbu, Kenneth C, additional, Medugu, Nubwa, additional, Nwajiobi-Princewill, Philip I, additional, Dramowski, Angela, additional, Sonda, Tolbert, additional, Hemed, Asia, additional, Fwoloshi, Sombo, additional, Ojok, David, additional, Scott, J Anthony G, additional, Whitelaw, Andrew, additional, Aliye, Jabir, additional, Assefa, Nega, additional, Edessa, Dumessa, additional, Oundo, Joseph, additional, Berihun, Mulu, additional, Dankwah, Thomas, additional, Osei, Mary M, additional, Fandoh, Maud, additional, Gakpo, Margaret, additional, Mulunda, Caroline, additional, Mvera, Benedict, additional, Chimenya, Mabvuto, additional, Feasey, Nicholas, additional, Mallewa, Jane, additional, Abdulraheem, Khadija, additional, Akujobi, Tobechi A, additional, Okonkwo, Chinelo H, additional, Britz, Luzell, additional, Bulbula, André N H, additional, Fataar, Aaqilah, additional, Mmbaga, Blandina T, additional, Ng'unda, Neema, additional, Chirwa, Uchizi, additional, Kakula, Nyambe, additional, Mutemba, Charles, additional, and Nakazwe, Ruth, additional

Published
2023
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6. Occurrence of Carbapenemases, Extended-Spectrum Beta-Lactamases and AmpCs among Beta-Lactamase-Producing Gram-Negative Bacteria from Clinical Sources in Accra, Ghana

Author

Owusu, Felicia A., primary, Obeng-Nkrumah, Noah, additional, Gyinae, Esther, additional, Kodom, Sarkodie, additional, Tagoe, Rhodalyn, additional, Tabi, Blessing Kofi Adu, additional, Dayie, Nicholas T. K. D., additional, Opintan, Japheth A., additional, and Egyir, Beverly, additional

Published
2023
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11. Mortality Associated with 3 rd Generation Cephalosporin Resistance in Enterobacterales Bloodstream Infections at Eight Sub-Saharan African Hospitals, a Prospective Cohort Study (MBIRA)

Author

Aiken, Alexander Michael, primary, Rehman, Andrea M., additional, de Kraker, Marlieke E. A., additional, Madrid, Lola, additional, Kebede, Meron, additional, Labi, Appiah-Korang, additional, Obeng-Nkrumah, Noah, additional, Nyamwaya, Brian, additional, Kagucia, Wangeci, additional, Cocker, Derek, additional, Kawaza, Kondwani, additional, Lester, Rebecca, additional, Iregbu, Kenneth C., additional, Medugu, Nubwa, additional, Nwajiobi-Princewill, Philip I., additional, Dramowski, Angela, additional, Sonda, Tolbert B., additional, Hemed, Asia, additional, Fwoloshi, Sombo, additional, Ojok, David, additional, Scott, J. Anthony G., additional, Whitelaw, Andrew, additional, Aliye, Jabir, additional, Assefa, Nega, additional, Edessa, Dumessa, additional, Oundo, Joe, additional, Berihun, Mulu, additional, Dankwah, Thomas, additional, Osei, Mary M., additional, Fandoh, Maud, additional, Mulunda, Caroline, additional, Mvera, Benedict, additional, Chimenya, Mabvuto, additional, Feasey, Nicholas A., additional, Mallewa, Jane, additional, Akujobi, Tobechi A., additional, Okonkwo, Chinelo H., additional, Britz, Luzell, additional, Bulabula, Andre, additional, Fataar, Aaqilah, additional, Mmbaga, Blandina T., additional, Ng&apos;unda, Neema, additional, Chirwa, Uchizi, additional, Kakula, Nyambe, additional, Mutemba, Charles, additional, and Nakazwe, Ruth, additional

Published
2023
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17. Treatment and control of invasive Gram-negative bacterial infection in eight hospitals across sub-Saharan Africa: a cross-sectional study

Author

Aiken, Alexander M., primary, Nyamwaya, Brian, additional, Madrid, Lola, additional, Edessa, Dumessa, additional, Labi, Appiah-Korang, additional, Obeng-Nkrumah, Noah, additional, Mwabaya, William, additional, Chimenya, Mabvuto, additional, Cocker, Derek, additional, Iregbu, Kenneth C., additional, Nwajiobi-Princewill, Philip I.P., additional, Dramowski, Angela, additional, Sonda, Tolbert, additional, Mmbaga, Blandina Theophil, additional, Ojok, David, additional, Fwoloshi, Sombo, additional, Scott, J. Anthony G., additional, Whitelaw, Andrew, additional, and collaborators, MBIRA study, additional

Published
2022
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19. Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented

Author

D’Arcy, Nikki, primary, Ashiru-Oredope, Diane, additional, Olaoye, Omotayo, additional, Afriyie, Daniel, additional, Akello, Zainab, additional, Ankrah, Daniel, additional, Asima, Derrick Mawuena, additional, Banda, David C., additional, Barrett, Scott, additional, Brandish, Claire, additional, Brayson, Joseph, additional, Benedict, Peter, additional, Dodoo, Cornelius C., additional, Garraghan, Frances, additional, Hoyelah, Josephyn, additional, Jani, Yogini, additional, Kitutu, Freddy Eric, additional, Kizito, Ismail Musoke, additional, Labi, Appiah-Korang, additional, Mirfenderesky, Mariyam, additional, Murdan, Sudaxshina, additional, Murray, Caoimhe, additional, Obeng-Nkrumah, Noah, additional, Olum, William J’Pathim, additional, Opintan, Japheth Awuletey, additional, Panford-Quainoo, Edwin, additional, Pauwels, Ines, additional, Sefah, Israel, additional, Sneddon, Jacqueline, additional, St. Clair Jones, Anja, additional, and Versporten, Ann, additional

Published
2021
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21. Whole Genome Sequencing and Antimicrobial Resistance of Staphylococcus aureus from Surgical Site Infections in Ghana

Author

Egyir, Beverly, primary, Bentum, Jeannette, additional, Attram, Naiki, additional, Fox, Anne, additional, Obeng-Nkrumah, Noah, additional, Appiah-Korang, Labi, additional, Behene, Eric, additional, Kumordjie, Selassie, additional, Yeboah, Clara, additional, Agbodzi, Bright, additional, Bentil, Ronald Essah, additional, Tagoe, Rhodalyn, additional, Kofi Adu Tabi, Blessing, additional, Owusu, Felicia, additional, Dayie, Nicholas T. K. D., additional, Donkor, Eric S., additional, Nsaful, Josephine, additional, Asah-Opoku, Kwaku, additional, Nyarko, Edward, additional, Asumanu, Edward, additional, Larsen, Anders Rhod, additional, Wolfe, David M., additional, and Letizia, Andrew G., additional

Published
2021
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22. Erratum to: Mortality attributable to third-generation cephalosporin resistance in Gram-negative bloodstream infections in African hospitals: a multi-site retrospective study

Author

Dramowski, Angela, primary, Ong’ayo, Gerald, additional, Rehman, Andrea M, additional, Whitelaw, Andrew, additional, Labi, Appiah-Korang, additional, Obeng-Nkrumah, Noah, additional, Ndir, Awa, additional, Magwenzi, Marcelyn T, additional, Onyedibe, Kenneth, additional, Wolkewitz, Martin, additional, de Kraker, Marlieke E A, additional, Scott, J Anthony G, additional, and Aiken, Alexander M, additional

Published
2021
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26. Additional file 1: of Antibiotic use in surgical units of selected hospitals in Ghana: a multi-centre point prevalence survey

Author

Bediako-Bowan, Antoinette, Owusu, Enid, Appiah-Korang Labi, Obeng-Nkrumah, Noah, Gifty Sunkwa-Mills, Bjerrum, Stephanie, Japheth Opintan, Bannerman, Cynthia, Küre MøLbak, JøRgen Kurtzhals, and Mercy Newman

Abstract

Table S1: Combination of antibiotics prescribed in patients. This shows antibiotic combinations prescribed in patients. Each column is the antibiotic group added on to the initial column for the 382 patients. A row gives an indication of antibiotics combination for patients (number of patients on that antibiotic). NB. 169 patients were on 1 antibiotic, 178 patients on 2 antibiotics, 29 patients on 3 antibiotics and 6 patients on 4 antibiotics. (DOCX 18 kb)

Published
2019
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27. MOESM1 of Household cockroaches carry CTX-M-15-, OXA-48- and NDM-1-producing enterobacteria, and share beta-lactam resistance determinants with humans

Author

Obeng-Nkrumah, Noah, Appiah-Korang Labi, Blankson, Harriet, Awuah-Mensah, Georgina, Oduro-Mensah, Daniel, Judelove Anum, Teye, James, Kwashie, Solomon, Bako, Evariste, Ayeh-Kumi, Patrick, and Asmah, Richard

Subjects
education, health care economics and organizations
Abstract

Additional file 1: Table S1. Oligonucleotides and PCR conditions used for amplification (internal primers included for sequencing).

Published
2019
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28. Antibiotic use in surgical units of selected hospitals in Ghana:a multi-centre point prevalence survey

Author

Bediako-Bowan, Antoinette A. A., Owusu, Enid, Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Sunkwa-Mills, Gifty, Bjerrum, Stephanie, Opintan, Japheth Awuletey, Bannerman, Cynthia, Mølbak, Kåre, Kurtzhals, Jørgen Anders Lindholm, Newman, Mercy Jemima, Bediako-Bowan, Antoinette A. A., Owusu, Enid, Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Sunkwa-Mills, Gifty, Bjerrum, Stephanie, Opintan, Japheth Awuletey, Bannerman, Cynthia, Mølbak, Kåre, Kurtzhals, Jørgen Anders Lindholm, and Newman, Mercy Jemima

Abstract

BACKGROUND: Improper use of antibiotics leads to the emergence of resistant microorganisms as well as drug toxicity, increased healthcare costs, morbidity and mortality. Globally, an estimated 25-68% of hospitalized patients receive suboptimal antibiotic regimes. Information on the extent of this problem in Ghana is currently limited, particularly in surgical units. To strategize for interventions, we estimated the antibiotic use prevalence in surgical departments in a country-wide point prevalence survey (PPS) in Ghana.METHODS: Between October 2016 and December 2016, we conducted a cross-sectional multi-center country-wide PPS. This involved an audit of in-patients' records from all units/departments of ten systematically selected hospitals in Ghana. Data were collected with a standardized questionnaire, adopted from the European Centre for Disease Prevention and Control. In this report, we present data on antibiotic use from the surgical units.RESULTS: Of 2107 eligible patients included in the PPS, 540 patients were identified in surgical units, of which 70.7% (382/540) received antibiotic therapy. A total of 636 antibiotic prescriptions were issued to these surgical patients; 224 (58.6%) for treatment, including 50 for treatment of hospital-acquired infections, and 144 (37.7%) for prophylaxis (medical and surgical). Median duration of antibiotic therapy prior to the survey was 5 days (interquartile range (IQR): 3-8 days). Surgical prophylaxis was administered for longer than the recommended one day in 107 of 144 (88.4%) patients. The choice of antibiotics was largely similar for community- and hospital-acquired infections as well as for prophylaxis. Only 3.7% of patients had microbiological analysis done on clinical samples.CONCLUSION: We found a high prevalence of antibiotic use, with the choice of antibiotics, in some cases, inconsistent with the country's treatment guidelines. Antibiotics were administered for long duration including an

Published
2019

30. Additional file 1 of Physiciansâ knowledge, attitudes, and perceptions concerning antibiotic resistance: a survey in a Ghanaian tertiary care hospital

Author

Appiah-Korang Labi, Obeng-Nkrumah, Noah, Bjerrum, Stephanie, Nii Aryee, Yaw Ofori-Adjei, Yawson, Alfred, and Mercy Newman

Subjects
behavioral disciplines and activities
Abstract

Survey instrument. This comprised a 40-item questionnaire for assessing the knowledge, attitudes and perceptions on antibiotic resistance among physicians in Korle-Bu Teaching Hospital. (PDF 1638 kb)

Published
2018
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34. Antibiotic prescribing in paediatric inpatients in Ghana:a multi-centre point prevalence survey

Author

Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Sunkwa-Mills, Gifty, Bediako-Bowan, Antoinette, Akufo, Christiana, Bjerrum, Stephanie, Owusu, Enid, Enweronu-Laryea, Christabel, Opintan, Japheth Awuletey, Kurtzhals, Jorgen Anders Lindholm, Newman, Mercy Jemima, Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Sunkwa-Mills, Gifty, Bediako-Bowan, Antoinette, Akufo, Christiana, Bjerrum, Stephanie, Owusu, Enid, Enweronu-Laryea, Christabel, Opintan, Japheth Awuletey, Kurtzhals, Jorgen Anders Lindholm, and Newman, Mercy Jemima

Abstract

BACKGROUND: Excessive and inappropriate use of antibiotics in hospitalised patients contributes to the development and spread of antibiotic resistance. Implementing a stewardship programme to curb the problem requires information on antibiotic use. This study describes a multicentre point prevalence of antibiotic use among paediatric inpatients in Ghana.METHODS: Data were extracted from a multicentre point prevalence survey of hospital acquired infections in Ghana. Data were collected between September 2016 and December 2016 from ten hospitals through inpatient folder and chart reviews using European Centre for Disease Control (ECDC) adapted data collection instrument. From each site, data were collected within a 12-h period (8 am to 8 pm) by a primary team of research investigators and a select group of health professionals from each participating hospital.RESULTS: Among 716 paediatric inpatients, 506 (70.6%; 95% confidence interval (CI): 67.2 to 74.0%) were on antibiotics. A significant proportion of antibiotics (82.9%) was prescribed for infants compared to neonates (63.9%) and adolescents (60.0%). The majority of patients (n = 251, 49.6%) were prescribed two antibiotics at the time of the survey. The top five classes of antibiotics prescribed were third generation cephalosporins (n = 154, 18.5%) aminoglycosides (n = 149, 17.9%), second generation cephalosporins (n = 103,12.4%), beta lactam resistant penicillins (n = 83, 10.0%) and nitroimidazoles (n = 82, 9.9%). The majority of antibiotics (n = 508, 61.0%) were prescribed for community acquired infections. The top three agents for managing community acquired infections were ceftriaxone (n = 97, 19.1%), gentamicin (n = 85, 16.7%) and cefuroxime (n = 73, 14.4%).CONCLUSION: This study points to high use of antibiotics among paediatric inpatients in Ghana. Cephalosporin use may offer an important target for reduction through antibiotic stewardship programmes.

Published
2018

35. Physicians' knowledge, attitudes, and perceptions concerning antibiotic resistance:a survey in a Ghanaian tertiary care hospital

Author

Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Bjerrum, Stephanie, Aryee, Nii Armah Adu, Ofori-Adjei, Yaw Adjei, Yawson, Alfred E., Newman, Mercy J., Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Bjerrum, Stephanie, Aryee, Nii Armah Adu, Ofori-Adjei, Yaw Adjei, Yawson, Alfred E., and Newman, Mercy J.

Abstract

Background: Understanding the knowledge, attitudes and practices of physicians towards antibiotic resistance is key to developing interventions aimed at behavior change. The survey aimed to investigate physicians' knowledge and attitudes towards antibiotic resistance in a tertiary-care hospital setting in Ghana. Methods: We conducted a cross-sectional respondent-driven survey using a 40-item, anonymous, voluntary, traditional paper-and-pencil self-administered questionnaire among 159 physicians at Korle-Bu Teaching Hospital. Single and multi-factor analysis were conducted to assess the study objectives. Results: The survey was completed by 159 of 200 physicians (response rate of 79.5%). Of physicians, 30.1% (47/156) perceived antibiotic resistance as very important global problem, 18.5% (29/157) perceived it as very important national problem and only 8.9% (14/157) thought it as a very important problem in their hospital. Methicillin resistant Staphylococcus aureus was the most known about antibiotic resistant bacteria of public health importance followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and vancomycin resistant enterococci (VRE). In multiple logistic regression analysis, senior physicians were nearly 3 times more likely to know about CRE than junior physicians. The odds of knowing about VRE increased over 4.5 times from being a junior to becoming senior physician. Among junior physicians, age had no associated effect on their knowledge of VRE or CRE. Conclusions: Physicians in this survey showed variable knowledge and perceptions on antibiotic resistance. Introducing educational programs on antibiotic resistance would be a useful intervention and should focus on junior physicians.

Published
2018

36. Household cockroaches carry CTX-M-15, OXA-48 and NDM-1, and share beta-lactam resistance determinants with humans

Author

Obeng-Nkrumah, Noah, primary, Labi, Appiah-Korang, additional, Blankson, Harriet, additional, Awuah-Mensah, Georgina, additional, Oduro-Mensah, Daniel, additional, Anum, Judelove, additional, Teye, James, additional, Kwashie, Solomon Dzidzornu, additional, Bako, Evariste, additional, Ayeh-Kumi, Patrick Ferdinand, additional, and Asmah, Richard, additional

Published
2018
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38. Additional file 1: Table S1. of Neonatal bloodstream infections in a Ghanaian Tertiary Hospital: Are the current antibiotic recommendations adequate?

Author

Appiah-Korang Labi, Obeng-Nkrumah, Noah, Bjerrum, Stephanie, Christabel Enweronu-Laryea, and Mercy Newman

Subjects
body regions
Abstract

Logistic regression models using linear or restricted cubic spline function (with the lowest AIC) of neonatesâ age. Table S2. Changes in the odds of antibiotic resistance with age of neonates to various antibiotic combinations using multivariable logistic regression models with linear spline function. (DOCX 19 kb)

Published
2016
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39. MOESM1 of Malaria, helminths and malnutrition: a cross-sectional survey of school children in the South-Tongu district of Ghana

Author

Ayeh-Kumi, Patrick, Kantanka Addo-Osafo, Attah, Simon, Tetteh-Quarcoo, Patience, Obeng-Nkrumah, Noah, Awuah-Mensah, Georgina, Abbey, Harriet, Akua Forson, Momodou Cham, Listowell Asare, Kwabena Duedu, and Asmah, Richard

Abstract

Additional file 1. Questionnaire for data collection. Data on participants characteristics were collected via interviews using standardized questionnaires. The questionnaire abstracted information regarding the following demographics (gender and age), childâ s knowledge of causes of malaria, helminth infections and schistosomiasis, deworming, availability of toileting facilities in household, sources of household water, childâ s activity in any river and parent/guardian educational level. We also determined the household socio-economic status using proxy measures based on the World Bank asset scores for Ghana. For each enrolee, anthropometric measurements including height and weight were determined.

Published
2016
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44. Malaria, helminths and malnutrition: a cross-sectional survey of school children in the South-Tongu district of Ghana

Author

Ayeh-Kumi, Patrick Ferdinand, primary, Addo-Osafo, Kantanka, additional, Attah, Simon Kwaku, additional, Tetteh-Quarcoo, Patience Borkor, additional, Obeng-Nkrumah, Noah, additional, Awuah-Mensah, Georgina, additional, Abbey, Harriet Naa Afia, additional, Forson, Akua, additional, Cham, Momodou, additional, Asare, Listowell, additional, Duedu, Kwabena Obeng, additional, and Asmah, Richard Harry, additional

Published
2016
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50. Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study.

Author

Aiken AM, Nyamwaya B, Madrid L, Edessa D, Labi AK, Obeng-Nkrumah N, Mwabaya W, Chimenya M, Cocker D, Iregbu KC, Princewill-Nwajiobi PIP, Dramowski A, Sonda T, Mmbaga BT, Ojok D, Fwoloshi S, Scott JAG, and Whitelaw A

Subjects
Humans, Cross-Sectional Studies, Anti-Bacterial Agents therapeutic use, Hospitals, Africa South of the Sahara, Bacterial Infections drug therapy, Sepsis drug therapy
Abstract

Background: Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study. Methods: We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI). Results: Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score: median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions: median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients. Conclusions: There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, patient-level use reflected in-hospital drug availability, suggesting external antibiotics supply was infrequent. Antimicrobial resistant bacterial infections could plausibly show different clinical impacts across sub-Saharan Africa due to this contextual variation., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Aiken AM et al.)

Published
2023
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