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. 2022 Jul 7;2(1):e111.
doi: 10.1017/ash.2022.252. eCollection 2022.

High levels of surgical antibiotic prophylaxis: Implications for hospital-based antibiotic stewardship in Sierra Leone

Sulaiman Lakoh  1   2   3   4 , Joseph Sam Kanu  1   2 , Sarah K Conteh  2 , James B W Russell  1   2 , Stephen Sevalie  1   3   5 , Christine Ellen Elleanor Williams  1   2 , Umu Barrie  4 , Aminata Kadie Kabia  5 , Fatmata Conteh  2 , Mohamed Boie Jalloh  1   5 , Gibrilla F Deen  1   2 , Mustapha S Kabba  1   2 , Aiah Lebbie  1   2 , Ibrahim Franklyn Kamara  6 , Bobson Derrick Fofanah  6 , Anna Maruta  6 , Christiana Kallon  2 , Foday Sahr  1   5 , Mohamed Samai  1   2 , Olukemi Adekanmbi  7   8 , Le Yi  9 , Xuejun Guo  9 , Rugiatu Z Kamara  10 , Darlinda F Jiba  2 , Joseph Chukwudi Okeibunor  11 , George A Yendewa  12   13   14 , Emmanuel Firima  15   16   17   18
Affiliations

High levels of surgical antibiotic prophylaxis: Implications for hospital-based antibiotic stewardship in Sierra Leone

Sulaiman Lakoh et al. Antimicrob Steward Healthc Epidemiol. .

Abstract

Objective: Despite the impact of inappropriate prescribing on antibiotic resistance, data on surgical antibiotic prophylaxis in sub-Saharan Africa are limited. In this study, we evaluated antibiotic use and consumption in surgical prophylaxis in 4 hospitals located in 2 geographic regions of Sierra Leone.

Methods: We used a prospective cohort design to collect data from surgical patients aged 18 years or older between February and October 2021. Data were analyzed using Stata version 16 software.

Results: Of the 753 surgical patients, 439 (58.3%) were females, and 723 (96%) had received at least 1 dose of antibiotics. Only 410 (54.4%) patients had indications for surgical antibiotic prophylaxis consistent with local guidelines. Factors associated with preoperative antibiotic prophylaxis were the type of surgery, wound class, and consistency of surgical antibiotic prophylaxis with local guidelines. Postoperatively, type of surgery, wound class, and consistency of antibiotic use with local guidelines were important factors associated with antibiotic use. Of the 2,482 doses administered, 1,410 (56.8%) were given postoperatively. Preoperative and intraoperative antibiotic use was reported in 645 (26%) and 427 (17.2%) cases, respectively. The most commonly used antibiotic was ceftriaxone 949 (38.2%) with a consumption of 41.6 defined daily doses (DDD) per 100 bed days. Overall, antibiotic consumption was 117.9 DDD per 100 bed days. The Access antibiotics had 72.7 DDD per 100 bed days (61.7%).

Conclusions: We report a high rate of antibiotic consumption for surgical prophylaxis, most of which was not based on local guidelines. To address this growing threat, urgent action is needed to reduce irrational antibiotic prescribing for surgical prophylaxis.

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Figures

Fig. 1.
Fig. 1.
(a) Total antibiotic consumption presented as DDD per 100 bed days by WHO AWaRe category showing contributions from preoperative, intraoperative, and postoperative periods. (b) Proportion of total antibiotic DDD per 100 bed days by WHO AWaRe category during preoperative, intraoperative, and postoperative periods. (c) Antibiotic consumption and (d) percentage consumption by WHO AWaRe category in 4 hospitals in Freetown, Sierra Leone. Note. CH, Connaught Hospital; LGH, Lumley Government Hospital; MH, Military Hospital; and MGH, Makeni Government Hospital.
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