Meropenem Utilization, Antimicrobial Resistance Patterns and Factors Influencing Meropenem Prescribing and Adherence to Guidelines by Clinicians at Kenyatta National hospital, Kenya

Abstract

Background: In hospitalized patients, antibiotics are the most commonly prescribed drugs. The rising level of antibiotic resistance, caused by frequent and inappropriate use of antimicrobial agents, is a major concern of health care systems throughout the world. Meropenem is a second-generation carbapenem with a broad spectrum of activity against a majority of gram-positive, gram-negative and anaerobic bacteria, hence it is prone to misuse. and this raises concerns about the emergence of antimicrobial resistance in Kenya and beyond. Objectives: The main objective was to describe meropenem utilization, antimicrobial resistance patterns and factors that influence meropenem prescribing by clinicians at Kenyatta National Hospital. Methods: The study was conducted in two parts at Kenyatta National Hospital. The first was a descriptive quantitative retrospective study describing meropenem utilization patterns for the period between January 2016 and December 2017. Patient files were reviewed. The second part was a cross-sectional study on meropenem prescribing practices by clinicians by use of a self-administered questionnaire. Convenient sampling was applied. All the abstracted data were subjected to descriptive data analysis. Inferential data analysis was carried out and a chi-square test was used. The level of significance was set at 0.05. Data analysis was done using SPSS version 20 software. Approval to carry out this study was granted by Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UoN-ERC) Results: A total of 452 medical records of patients on meropenem were reviewed. Meningitis 45 (27.6%) was the major indication in children aged 12 years and below while soft tissue infection, 75 (26%) was the major indication in patients aged 13 years and above. 134 (82.2%) children received the optimal dose. Meropenem was used as empirical therapy in 348 (77%) of the patients. Gram-negative bacteria were the major isolates, (97.6%) and resistance was high with Acinetobacter baumannii 9 (90.0%). A total of 39 clinicians were interviewed of whom 20 (51.3%) were females. There was a statistically significant association between specialization and meropenem prescribing practices (p value=0.04). Most clinicians, 22 (56.4%) relied on the advice of an infectious disease specialist before prescribing meropenem. Conclusion: This study has shown that meropenem was mainly used empirically. Continuous medical education, functional drug therapeutic committees and regular drug use research programs remain important aspects in promoting rational antimicrobial use.