Abstract
BackgroundHuman antibacterial exposure occur in different ways including consumption of animal and agricultural products as well as use of prescribed and non-prescribed agents. We estimated the prevalence and explored the predictors of antibacterial use among patients presenting to hospitals in northern Uganda.MethodsFour hundred fifty (450) patients were randomly selected and antibacterial use prior to hospital visit measured using a questionnaire and urine antibacterial activity assay. Urine antibacterial bioassays were performed using American type culture collections of Escherichia coli, Bacillus subtilis and Streptococcus pyogenes. Data were analysed using STATA 12.0 at 95 % confidence level.ResultsOf 450 patients interviewed, 62.2 % had used antibacterial agents. Urine antibacterial activity was detected in 30.4 % of the samples tested. Of the 85 patients who reported not taking any antibacterial at home, 16 (18.8 %) had urine with antibacterial activity. Most test bacteria, E. coli (74.5 %), B. subtilis (72.6 %) and S. pyogens (86.7 %) were sensitive to urine of patients who reported using antibacterial drugs before hospital visit. From the interview, metronidazole 15.6 % (70/450), amoxicillin 12 % (54/450), and ciprofloxacin 10.4 % (47/450) were the most used antibacterial agents. Patient age (OR, 2.45: 95 % CI: 1.02–5.91: P = 0.024), time-lag between last drug intake and hospital visit (OR: 3.18: 95 % CI: 1.44–7.0: P < 0.0001), and time-lag between illness onset and hospital visit (OR: 1.89: 95 % CI: 0.38–5.1: P = 0.027) predicted the use of antibacterial agents before hospital visit.DiscussionCommunity antibacterial use continues to take place in an unregulated manner. In addition, physiciansrarely seek to ascertain prior use of antibacterial agents among patients presenting to hospitals. This couldhave a bearing on patient treatment outcomes.ConclusionKnowledge of prior antibacterial use among patients presenting to hospitals is useful to physicians in ensuring antibacterial stewardship.
Highlights
Human antibacterial exposure occur in different ways including consumption of animal and agricultural products as well as use of prescribed and non-prescribed agents
Knowledge of prior antibacterial use among patients presenting to hospitals is useful to physicians in ensuring antibacterial stewardship
Health workers rely on self-report in assessing antibacterial use among patients prior to hospital visit, information critical for appropriate therapeutic choices
Summary
Human antibacterial exposure occur in different ways including consumption of animal and agricultural products as well as use of prescribed and non-prescribed agents. We estimated the prevalence and explored the predictors of antibacterial use among patients presenting to hospitals in northern Uganda. Antibacterial use both in hospital settings and different communities of the world is increasing exponentially. The use of antibacterial agents prior to hospital visit is common especially in developing countries and has the potential of influencing patient treatment outcomes [6, 7]. The high associated cost in addition to the technical expertise required limits its use as a point of care technique for establishing prior antibacterial use especially in resource constrained countries like Uganda. Previous studies have reported cheap and reliable method of measuring prior antibacterial use among patients who visit hospitals in developing countries using urine antibacterial activity bioassay [11, 12]
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