Antimicrobial Use Practices in Mbagathi Hospital, Nairobi-kenya- a Point Prevalence Survey

Abstract

Background: Antimicrobials are indispensable in the practice of medicine. Their misuse is one of the great forces behind the rapid growth of resistance. Antibiotics are the most frequently prescribed class of antimicrobials, locally and globally. However this use is very often irrational. This increases risk of serious untoward drug reactions, poor treatment outcomes, waste of resources as well as antimicrobial resistance. Antimicrobial resistance is a grave and growing public health threat today. Inappropriate and unnecessary use of antimicrobials is a big contributor to the growth of resistant pathogens. Advocating and promoting rational use of antimicrobial agents through antimicrobial stewardship programs is pivotal in curbing increasing growth of resistance. The World Health Organization recommends that each facility drafts its antimicrobial use policy. Study objective: The main objective of this study was to establish patterns of antimicrobial use in Mbagathi Hospital, Nairobi County, Kenya. Methods: A Point Prevalence Survey was conducted in all wards of Mbagathi Hospital, in Nairobi County. Universal sampling was employed, whereby all patients who met the inclusion criteria were included in the study. Participants were included in the study if they met the following criteria: Age ranged from 0 days to 100 years and were admitted before 8 am on the survey day. This is in line with the Global point prevalence survey protocol, 2018. Patient demographic and clinical data were extracted from the patient files, treatment sheets, laboratory culture and sensitivity reports. All raw data collected was entered into EPI info version 7 and a database created. Descriptive and linear regression data analysis was conducted. Results: A total of 185 patient records were sampled of whom 146 (78.9%) received at least one antimicrobial. Overall, 363 antimicrobials were prescribed during current admission and on average each participant was prescribed for 2 antimicrobials. The most important risk factors for number of antimicrobials used were HIV status, prior hospitalization in the last 90 days, catheterization and nutritional status. Antibiotics formed the biggest proportion of antimicrobials prescribed in Mbagathi Hospital ( n=294, 81%) followed by antivirals ( n=48, 13%) and the least prescribed were antimalarials and antifungals at 3% each. Most commonly prescribed antimicrobial was ceftriaxone at 46% while the commonest indication for antimicrobial use was pneumonia with a prevalence of 33%. Culture and sensitivity tests were only ordered in 7 (3.8%) of the cases. Conclusion: The prevalence of antimicrobial use was above the World Health Organization (WHO) reference value of 30% or less. Ceftriaxone was used to a great extent. Empiric prescribing of antimicrobials was mainly the practice as culture and sensitivity testing were not routinely done in

Mbagathi hospital. The hospital medicines and therapeutics committee should set up an antimicrobial stewardship committee to help in judicious antimicrobial use.