Antimicrobial sensitivity testing in 3 Ugandan Hospitals
Antimicrobial resistance (AMR) is a global health threat responsible for increased hospital costs and mortality. The WHO global action plan on AMR recommends antimicrobial sensitivity testing (AST) and surveillance of antibiotic use to address this threat. We aimed to determine the utility of AST in three Ugandan hospitals. We conducted a cross-sectional study was conducted in three major referral hospitals in Uganda. We used abstraction checklists to collect data on AST requests, AST performed, AST turnaround time, and dispensed antibiotics from in-patient files, lab, and pharmacy records. Antibiotic data were summarized using proportions. The dispensed antibiotics and AST antibiotic-disks were compared using spearman’s rank correlation test. Of the 607 in-patient files reviewed, AST was requested in 24 (4.0%), and done in 13 (2.1%). All three hospitals used the Kirby-Bauer disk diffusion method for AST, with a median turnaround time of 5 days (IQR 4-8). While the frequently used AST antibiotic-disks were cotrimoxazole (13.0%), ampicillin (11.7%), and ceftriaxone (10.5%), the most dispensed antibiotics were metronidazole (30.3%), amoxicillin (19.6%) and ceftriaxone (14.8%). There was a weak correlation (r=0.313, p=0.120) between dispensed antibiotics and AST antibiotic-disks. We report an underutilization of AST, and the few tests that were performed were discordant with the most dispensed antibiotics. The commonly used disk diffusion method in hospitals of resource-limited settings is inexpensive but has a long turnaround time. We recommend alternative faster and cost-effective AST methods.
Steps to reproduce
We reviewed the pharmacy records for November and December 2013 to determine the antibiotic consumption of the three hospitals. From the microbiology laboratory records, we evaluated the AST technique used, performed tests and analytical turnaround time. For the performed tests, we captured the registration (specimen receipt) and result dispatch dates, ward, and antibiotic disks used. Analytic turnaround time was defined as the time interval between specimen receipt and registration, and issue of AST results. This interval includes time for bacterial identification, culture and AST. Pre- (test ordering, collection, labeling, transportation) and post- (physician receipt, interpretation and action) analytical time intervals of the diagnostic/microbiological cycle were unavailable. Treatment files with at least one antibiotic prescription on the in-patient wards were purposively sampled and reviewed to determine the AST request and performance rates. Data abstraction was performed using pre-tested abstraction checklists.