Antimicrobial point prevalence surveys in two Ghanaian hospitals : opportunities for antimicrobial stewardship

Afriyie, Daniel Kwame and Sefah, Israel A. and Sneddon, Jacqueline and MALCOM, William and McKinney, Rachel and Cooper, Lesley and Kurdi, Amanj and Godman, Brian and Seaton, R. Andrew (2019) Antimicrobial point prevalence surveys in two Ghanaian hospitals : opportunities for antimicrobial stewardship. JAC-Antimicrobial Resistance. ISSN 2632-1823 (In Press)

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    Abstract

    Background: Improved knowledge regarding antimicrobial use in Ghana is urgently needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPS) in hospitals. Objectives were: (i) provide baseline data in two hospitals (Keta Municipal Hospital – KMH and Ghana Police Hospital – GPH) and identify priorities for improvement; (ii) assess the feasibility of conducting PPS; (iii) compare results with others. Methods: Standard PPS design using the Global PPS paper forms, subsequently transferred to their template. Training undertaken by the Scottish team. Quality indicators included rationale for use; stop and review dates, and guideline compliance. Results: Prevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other beta-lactam antibiotics were the most prescribed in both hospitals, with third generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously (IV), duration was generally short with timely oral switching, and infections were mainly community acquired. Encouragingly, good documentation of the indications for antibiotic use in both hospitals and 50.0-66.0% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there appeared no missed doses. The duration of use for surgical prophylaxis was generally more than one day (69.0% in GPH and 77.0% in KMH). Conclusions: These two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible and relatively rapid, achieved with limited training. Targets for improvement identified included broad-spectrum antibiotics, duration of treatment and high empiric use.