Ceftriaxone Resistance in the Surgical Adult Intensive Care Unit at Muhimbili National Hospital, Dar es Salaam, Tanzania
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Abstract
Background: The resistance to first line agents, namely third generation cephalosporins, specifically ceftriaxone, has been clinically observed in a number of patients at Muhimbili National Hospital (MNH) medical wards. However, there has been no any study from the intensive care units with regards to resistance to ceftriaxone per se.
Objective: The objective of our study was to audit the use of ceftriaxone with STG adherence as the first line antibacterial agent on the prophylaxis and treatment of bacterial infections among patients admitted in the surgical Adult Intensive Care Unit (AICU) at MNH, Dar es Salaam, Tanzania.
Methods: This was a prospective descriptive cross-sectional clinical audit study, done from January, 2021 to December, 2021. Results were analyzed using SPSS 23.
Results: During one year of the study period, a total of 735 patients were admitted in the surgical MNH-AICU with different clinical diagnosis. A total of 731(99.50%) were included in the final analysis, with only 75(10.26%) having culture and sensitivity performed on them. Among all isolates, Klebsiella pneumoniae 34(45%) was the most predominant bacteria. Klebsiella pneumonia, Acinetobacter spp and Escherichia coli were 100% resistant to ceftriaxone (CRO) while five isolates of K. pneumoniae were resistant to all tested antibiotics including Meropenem. The STG adherence was only in 26(4.30%) patients out of 731 patients studied with regards to ceftriaxone prescription.
Conclusion: In this study, the majority of pathogens were due to multi-drug resistant (MDR) bacteria. The STG adherence was very low with regard to the use of ceftriaxone (4.30%). The resistance to Ceftriaxone was 100%; thus, Ceftriaxone should no longer be used as the first line for prophylaxis and treatment of bacterial infections in the surgical MNH-AICU and similar settings. Crucially, the establishment of dedicated Antimicrobial Stewardship Program (ASP) teams, along with rigorous education and strict adherence to defined guidelines, is of paramount importance to counteract and effectively reduce the observed antimicrobial resistance(AMR) burden.