Surveillance of antibiotic prescribing practices and trends of resistance at a private hospital in Zimbabwe

Gwayagwaya, Chipo Sitembile (2020-03)

Thesis (MSc)--Stellenbosch University, 2020.

Thesis

ENGLISH ABSTRACT : Introduction: Antibiotic resistance is a world-wide burden characterised by inappropriate prescribing practices, poor surveillance systems and poor laboratory capacity in the low income countries. Antibiotic prescribing practices relates to the way clinicians give antibiotics as treatment of infections. Monitoring of prescribing practices is of paramount importance so as to know the currents patterns, raise awareness on antibiotic usage and to create opportunities for antibiotic stewardship programmes. This study on surveillance of prescribing practices and trends of resistance at this facility in Zimbabwe is to raise awareness on antibiotic usage and to create an opportunity for antibiotic stewardship programmes. Methodology and results: In the course of the study 220 patients had their prescriptions reviewed for antibiotic prescribing patterns it was observed that Ceftriaxone was the most drug prescribed 176 patients got Ceftriaxone. Most patients got more than one antibiotic and 18 of the 220 got 5 antibiotics. A questionnaire was administered to 50 of the doctors who admit at this private healthcare facility to assess which guidelines they use to prescribe antibiotics. However, 32% responded to the questionnaire and most of the doctors do not use national guidelines but other guidelines to prescribe antibiotics. Microbiological data from blood cultures were reviewed from 2011-2015 to assess common pathogens and their susceptibility pattern. Total of 845 samples were reviewed 667 had no growth, 36 were contaminated and 142 had susceptibility results. The most common organism with resistance to almost all antibiotics tested was coagulase negative staphylococci and with a highest percentage of resistance to Cloxacillin at 89.09%. Conclusion: Development of a surveillance system to monitor prescribing practices and reporting of resistance patterns in low income countries healthcare facilities will reduce antibiotic resistance as it adds data to the national health systems and assist in the development of national antibiotic policy and antibiotic stewardship programmes.

AFRIKAANSE OPSOMMING : Agtergrond: Weerstand teen antibiotika is ‘n wêreld-wye las, wat gekarakteriseer word deur onbehoorlike voorskryf-praktyke, swak waaktoesigsisteme en swak laboratoriumkapasiteit in die lae-inkomste lande. Antibiotiese voorskryf-praktyke hou verband met die manier waarop klinici antibiotika as behandeling vir infeksies gee. Die monitering van voorskrywingspraktyke is van uiterse belang om die huidige patrone te ken, bewustheid te wek oor die gebruik van antibiotika en om geleenthede te skep vir programme vir die bestuur van antibiotika. Hierdie studie dek die waaktoesig oor voorskrywingspraktyke en weerstandigheid by die fasiliteit in Zimbabwe. Dis om bewustheid oor die gebruik van antibiotika te vermeerder en om 'n geleentheid te skep vir programme vir bestuur van antibiotika. Metodologie en resultate: Gedurende die studie was 220 pasiënte se voorskrifte ondersoek vir antibiotiese voorskrifpatrone. Keftriaksoon was die meeste voorgeskryf: 176 pasiënte het Keftriaksoon gekry. Die meeste pasiënte het meer as een antibiotika ontvang, en 18 van die 220 het 5 antibiotika ontvang. 'n Vraeboog is aan 50 dokters wat pasiënte in hierdie privaat gesondheidsorg-fasiliteit opneem gegee om te bepaal watter riglyne hulle gebruik om antibiotika voor te skryf. Die vraeboog is deur 32% voltooi. Die meeste dokters gebruik nie die nasionale riglyne nie, maar ander riglyne om antibiotika voor te skryf. Mikrobiologiese data van bloedkulture is vanaf 2011-2015 hersien om algemene patogene en hul sensitiviteitspatrone te bepaal. Altesaam 845 monsters is beoordeel, waarvan 667 geen groei gehad het nie, 36 gekontamineerd was en 142 sensitiviteitsresultate gehad het. Die algemeenste organisme met weerstand teen byna al die antibiotika wat getoets is, was koagulase-negatiewe stafilokokke en met 'n hoogste persentasie weerstand van 89,09% teen Cloxacillin. Gevolgtrekking: Die ontwikkeling van 'n waaktoesigstelsel om voorskrywingspraktyke te monitor en verslagdoening oor weerstandspatrone in gesondheidsorgfasiliteite in lae-inkomstelande sal antibiotiese weerstandigheid verminder, aangesien dit data tot die nasionale gesondheidstelsels toevoeg en help met die ontwikkeling van nasionale antibiotika-beleid en programme vir die bestuur van antibiotika.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107935
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