Abstract
BackgroundImproved knowledge regarding antimicrobial use in Ghana is needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPSs) in hospitals. Objectives were to: (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 PPSs; and (iii) compare results with other studies.MethodsStandard 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/review dates; and guideline compliance.ResultsPrevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other β-lactam antibiotics were the most frequently prescribed in both hospitals, with third-generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously, duration was generally short with timely oral switching and infections were mainly community acquired. Encouragingly, there was good documentation of the indications for antibiotic use in both hospitals and 50.0%–66.7% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there were no missed doses. The duration of use for surgical prophylaxis was generally more than 1 day (69.0% in GPH and 77.0% in KMH).ConclusionsThese two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible, relatively rapid and achieved with limited training. Targets for improvement identified included reduction of broad-spectrum antibiotics and duration of treatment.
Highlights
In Ghana Police Hospital (GPH), work to realign ward designations and address other issues with the Global PPS system (GPPSS) was required over 2 days data entry took a further 7 h
A number of general observations not specified within the GPPSS methodology were noted separately
There was a low prevalence of known HIV-positive patients and only three patients being treated for TB, no patients were observed with a record of penicillin allergy and no patients were being treated presumptively for infection with MRSA
Summary
Unnecessary use of antibiotics is a significant and modifiable driver for antimicrobial resistance (AMR), associated with increased morbidity and mortality[1] as well as cost.[2,3,4,5,6] AMR is of particular concern in low- and middle-income countries (LMICs), due to recent marked increases in antimicrobial utilization.[7,8,9,10] Rising AMR rates have resulted in regional, national and global initiatives to improve future antibiotic use through implementation of antimicrobial stewardship programmes (ASPs),[11,12,13,14,15,16,17,18,19] with variable implementation and outcomes in LMICs due to limited resources.[17,20,21,22,23,24,25]Inappropriate use of antimicrobials in hospitals is widely reported,[21,26,27,28,29,30,31,32,33,34,35] exacerbated by high rates of HIV, TB and malaria in sub-Saharan African countries,[21,36] coupled with variable diagnostic resources. Improved knowledge regarding antimicrobial use in Ghana is needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPSs) in hospitals. Objectives were to: (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 PPSs; and (iii) compare results with other studies
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