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Patterns of Antimicrobial Use in a Specialized Surgical Hospital in Southeast Nigeria: Need for a Standardized Protocol of Antimicrobial Use in the Tropics

Ugochukwu Uzodimma Nnadozie
Chukwuma David Umeokonkwo
Charles Chidiebele Maduba
Ifeanyichukwu I. Onah
Dorothy Igwe‑Okomiso
Iheuko S. Ogbonnaya
Cosmas Kenan Onah
Patric Chukwuemeka Okoye
Ann Versporten
Herman Goossens


Background: Antimicrobial resistance remains a growing global health menace. One of the key actions to curb this menace by the World Health Organization is antimicrobial stewardship (AMS). A prescription protocol is one of the cost‑effective AMS interventions in surgery. This study determines the patterns of antimicrobial usage in a hospital specialized in orthopedic and plastic surgeries care in Nigeria.

Methods: A cross-sectional survey was carried out at National Orthopaedic Hospital Enugu, a tertiary hospital specialized in orthopedic and plastic surgeries in Southeast Nigeria in May 2019. All the inpatients were included in the study. A standardized tool for point prevalence survey was used to collect data. Data were analyzed using Epi Info version 7.2.4.

Results: A total of 127 inpatients  participated in the survey with 387 antimicrobial encounters. The most common reasons for antimicrobial use were for the treatment of community-acquired infections (65.0%) and prophylaxis (29.4%). The decision for their use was made majorly on an empirical basis (92.4%). The reasons for antimicrobial prescriptions were documented in the majority (97.5%) of the cases and stop review dates in all (100%) of the prescriptions. Ceftriaxone (25.7%), tinidazole (21.9%), and metronidazole (14.6%) were the commonest antimicrobials prescribed among the patients.

Conclusion: Orthopedic and plastic surgery practices require tailored prophylactic antibiotic regimens in the tropics due to peculiarities of both the specialties and the subregion. The claim that existing protocols in the temperate regions may apply in the tropics has been questioned due to the microbial profile on the tropics.

Keywords: Antimicrobial protocol in surgery, antimicrobial resistance, antimicrobial stewardship, prophylactic antibiotics