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, 14 (8), e0220261
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Ceftriaxone Use in a Tertiary Care Hospital in Kilimanjaro, Tanzania: A Need for a Hospital Antibiotic Stewardship Programme

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Ceftriaxone Use in a Tertiary Care Hospital in Kilimanjaro, Tanzania: A Need for a Hospital Antibiotic Stewardship Programme

Tolbert B Sonda et al. PLoS One.

Abstract

Excessive use of antibiotics, especially watch group antibiotics such as ceftriaxone leads to emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries (LMICs), antibiotics are overused but data on consumption is scarcely available. We aimed at determining the extent and predictors of ceftriaxone use in a tertiary care university teaching hospital in Kilimanjaro, Tanzania. A hospital-based cross-sectional study was conducted from August 2013 through August 2015. Patients admitted in the medical, surgical wards and their respective intensive care units, receiving antimicrobials and other medications for various ailments were enrolled. Socio-demographic and clinical data were recorded in a structured questionnaire from patients' files and logistic regression was performed to determine the predictors for ceftriaxone use. Out of the 630 patients included in this study, 322 (51.1%) patients were on ceftriaxone during their time of hospitalization. Twenty-two patients out of 320 (6.9%) had been on ceftriaxone treatment without evidence of infection. Ceftriaxone use for surgical prophylaxis was 44 (40.7%), of which 32 (72.7%) and 9 (20.5%) received ceftriaxone prophylaxis before and after surgery, respectively. Three (6.8%) received ceftriaxone prophylaxis during surgery. Predicting factors for that the health facility administered ceftriaxone were identified as history of any medication use before referral to hospital [OR = 3.4, 95% CI (1.0-11.4), p = 0.047], bacterial infection [OR = 18.0, 95% CI (1.4-225.7, p = 0.025)], surgical ward [OR = 2.9, 95% CI (0.9-9.4), p = 0.078] and medical wards [OR = 5.0, 95% CI (0.9-28.3), p = 0.070]. Overall, a high ceftriaxone use at KCMC hospital was observed. Antimicrobial stewardship programs are highly needed to monitor and regulate hospital antimicrobial consumption, which in turn could help in halting the rising crisis of antimicrobial resistance.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. A forest plot to show univariable and multivariable regression analysis on factors predicting ceftriaxone use.
Referral (Transferred from another hospital), Medication (Patient on any medication), Wound (Any wound, including septic infected burn wound), Previous admission (Previous admission to hospital), Prior medical service (Any medical service before coming to hospital), Hospital stay (Length of hospital stay in days), Surgical ward 2 (Department of surgery ward 2), Medical ward 1 (Department of Medicine ward 2), Current Infection (A Presumptive diagnosis of infection present at admission).

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Grant support

This study was supported by DANIDA through Danida Fellowship Centre award number DFC No. 12-007DTU.
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