Prescription Practices and Usage of Antimicrobials in a Tertiary Teaching Hospital in Rwanda: A Call for Antimicrobial Stewardship
Acsa Igizeneza,
Leopold Bitunguhari,
Florence Masaisa,
Innocent Hahirwa,
Lorette D. Uwamahoro,
Osee Sebatunzi,
Nathalie Umugwaneza,
Ines Pauwels,
Ann Versporten,
Erika Vlieghe,
Ayman Ahmed,
Jean Claude S. Ngabonziza,
Caroline Theunissen
Affiliations
Acsa Igizeneza
Department of Microbiology and Parasitology, University of Rwanda, Huye P.O. Box 117, Rwanda
Leopold Bitunguhari
Department of Clinical Biology, University of Rwanda, Kigali P.O. Box 3286, Rwanda
Florence Masaisa
Department of Clinical Biology, University of Rwanda, Kigali P.O. Box 3286, Rwanda
Innocent Hahirwa
Department of Pharmacology and Toxicology, University of Rwanda, Kigali P.O. Box 655, Rwanda
Lorette D. Uwamahoro
Department of Clinical Biology, University of Rwanda, Kigali P.O. Box 3286, Rwanda
Osee Sebatunzi
Department of Clinical Biology, University of Rwanda, Kigali P.O. Box 3286, Rwanda
Nathalie Umugwaneza
Department of Surgery, University Teaching Hospital of Kigali, Kigali P.O. Box 655, Rwanda
Ines Pauwels
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
Ann Versporten
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
Erika Vlieghe
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
Ayman Ahmed
Unit of Applied Medical Sciences, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum 11111, Sudan
Jean Claude S. Ngabonziza
Department of Clinical Biology, University of Rwanda, Kigali P.O. Box 3286, Rwanda
Caroline Theunissen
Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
Background: Antimicrobial resistance (AMR) is a global problem that results in high morbidity and mortality, particularly in low- and middle-income countries. Inappropriate use of antimicrobials is a major driver of AMR. This study aimed to evaluate the rate and quality of antimicrobial prescription and use at the University Teaching Hospital of Kigali (CHUK), a tertiary-referral teaching hospital. Methodology: A point prevalence survey (PPS) of antimicrobial prescription was conducted using the Global PPS tool, including a healthcare-acquired infection (HAI) module. Results: On the day of the PPS, 39.3% (145/369) of inpatients were prescribed at least one antimicrobial. Out of the 259 prescribed antimicrobials, 232 (89.6%) were antibacterials, of which 151 (65.1%) belonged to the watch group of the WHO AWaRe classification. The top three antibiotics prescribed were cefotaxime (87; 37.5%), parenteral metronidazole (31; 13.4%), and meropenem (23; 9.9%). Stop or review dates for the prescribed antimicrobials were documented in 27/259 prescriptions (10.4%). Surgical prophylaxis (SP) was prescribed for longer than one day in 83.3% of 61 patients. Samples for culture were sent for 27.1% (63/232) of all the patients prescribed antibiotics. Conclusion: This PPS demonstrates multiple indicators of the poor use of antimicrobials, including the high prevalence usage of watch antibiotics and prolonged surgical prophylaxis and other poor-quality indicators. Thus, there is an urgent need for intervention to improve antimicrobial stewardship.
