Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

Background: Antimicrobial resistance (AMR) is a major clinical challenge globally. It is mainly a consequence of inappropriate prescribing and use of antibiotics. Antimicrobial stewardship (AMS) ensures that antibiotics are prescribed and used appropriately. This study assessed AMS practice in selected Nigerian hospitals.Methodology: This was a cross sectional survey of 20 Federal, State and Private tertiary hospitals randomly selected from the six geopolitical zones of Nigeria. Using an adapted WHO tool on AMS, data were collected from each hospital as regard the existence of AMS committee, Accountability and Responsibility, AMS actions, Education and Training, Monitoring and Evaluation, Infection Prevention and Control (IPC) practice, facilities to support AMS, and challenges to AMS implementation. Gaps and challenges to the implementation of the AMS among the hospitals were identified.Results: Only 6 (30%) of the 20 hospitals had AMS committees while 2 (10%) had any evidence of leadership commitment to AMS. All the hospitals had laboratory facilities to support culture and sensitivity testing. There were no regular AMS-related education or training, monitoring, evaluation or reporting activities in the hospitals, except in 7 (25%) that had participated in the global point prevalence survey (Global-PPS) of antimicrobial use and resistance being hosted by the University of Antwerp, Belgium. Challenges impeding AMS activities included lack of human and financial resources, prescribers’ opposition, lack of awareness and absence of AMS committees. Most of the gaps and challenges bordered on seeming lack of knowledge and inadequate communication among prescribers and other stakeholders.Conclusion: There is need for intense education and training activities for prescribers and other stakeholders, including but not limited to hospital administrators. Keywords: Survey, Antimicrobial Stewardship, Antimicrobial Resistance; Nigeria   French title: Mise en œuvre de la gestion des antimicrobiens dans les hôpitaux Nigérians: lacunes et défis Contexte: La résistance aux antimicrobiens (RAM) est un défi clinique majeur à l'échelle mondiale. C'estprincipalement une conséquence d'une prescription et d'une utilisation inappropriées d'antibiotiques. La gestion des antimicrobiens (AMS) garantit que les antibiotiques sont prescrits et utilisés de manière appropriée. Cette étude a évalué la pratique de l'AMS dans certains hôpitaux Nigérians. Méthodologie: Il s'agissait d'une enquête transversale de 20 hôpitaux tertiaires fédéraux, d'État et privéssélectionnés au hasard dans les six zones géopolitiques du Nigéria. À l'aide d'un outil OMS adapté sur l'AMS, des données ont été collectées auprès de chaque hôpital en ce qui concerne l'existence d'un comité AMS, la responsabilité et la responsabilité, les actions AMS, l'éducation et la formation, le suivi et l'évaluation, la  pratique de prévention et de contrôle des infections (IPC), les installations pour soutenir l'AMS. et les défis de la mise en œuvre de l'AMS. Les lacunes et les défis liés à la mise en œuvre de l'AMS parmi les hôpitaux ont été identifiés. Résultats: Seuls 6 (30%) des 20 hôpitaux avaient des comités AMS tandis que 2 (10%) avaient des preuves d'engagement du leadership envers l'AMS. Tous les hôpitaux disposaient d'installations de laboratoire pour soutenir la culture et les tests de sensibilité. Il n'y avait pas d'activités régulières d'éducation ou de formation, de suivi, d'évaluation ou de rapportage liées à la MGS dans les hôpitaux, sauf dans 7 (25%) qui avaient participé à l'enquête mondiale sur la prévalence ponctuelle (Global-PPS) de l'utilisation et de la résistance aux  antimicrobiens organisée par l'Université d'Anvers, Belgique. Les défis entravant les activités de l'AMS  comprenaient le manque de ressources humaines et financières, l'opposition des prescripteurs, le manque de sensibilisation et l'absence de comités AMS. La plupart des lacunes et des défis se limitaient à un manque apparent de connaissances et à une communication inadéquate entre les prescripteurs et les autres intervenants.Conclusion: Des activités d'éducation et de formation intensives sont nécessaires pour les prescripteurs et autres intervenants, y compris, mais sans s'y limiter, les administrateurs d'hôpitaux. Mots clés: enquête, gestion des antimicrobiens, résistance aux antimicrobiens; Nigeria   &nbsp

Corrigendum: Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

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Determination of antibacterial activity of Carica papaya (pawpaw) extracts

The quest for suitable and affordable alternatives in the face of increasing antimicrobial drugresistance has led researchers into exploring the use of plant extracts in the treatment of infections. Antibacterial activity of extracts of carica papaya (paw-paw) fruit was investigated using isolates from wound culture. These include: Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa and proteus species. These organisms were challenged with extracts from the seed, endocarp and epicarp.  The extracts demonstrated antibacterial activity as shown by their zones of inhibition and this was more pronounced with alcohol extracts than that of water.Staphylococcus aureus was the most susceptible with a minimum inhibition concentration (MIC) of 1:64 while Enterococcus faecalis was the least sensitive. The extractswere also heat stable. The demonstration of antibacterial activity against both grampositive and gramnegative bacteria demonstrates that the paw-pawplant is a potential source for the productionof antimicrobial drugs.Researchers should be encouraged towards utilizing this plant as well as others with such potential in other to curb the menace of antimicrobial drug resistance in the near future.Keywords: Carica papaya extracts, antibacterial activit

Multidrug‑Resistant Tuberculosis in Imo State, Southeast, Nigeria

Background: Multidrug-resistant tuberculosis (MDR-TB) is a global health challenge. The emergence of MDR TB has contributed remarkably to the spread of tuberculosis and also poses a threat, which if not effectively addressed may wipe out the achievements of previous efforts in controlling tuberculosis. Objective: This study was aimed at detecting MDR-TB among patients in a setting prevalent with tuberculosis and HIV in Southeast, Nigeria. Method: Sputum specimens collected from 740 suspected tuberculosis (TB) patients were screened for acid-fast bacilli (AFB). All the 111 AFB positive samples were subjected to culture on Lowenstein-Jensen (LJ) medium and Mycobacterium Growth Indicator Tube (MGIT) 960 TB system. The isolates were then confirmed as Mycobacterium tuberculosis using SD Bioline Rapid Diagnostic Tests before being subjected to drug susceptibility testing to first-line anti-TB drugs. MDR-TB was determined by isolates being resistant to both isoniazid and rifampicin. HIV testing was performed for participants included in the study using standard rapid diagnostic tests. Result: Out of the 111 AFB-positive sputum samples, 65 (58.6%) were culture-positive for Mycobacterium tuberculosis. MDR-TB was found in 2 ([3.1%] 95% CI = 0.0–7.3) of the culture-positive samples. The rate of TB and HIV coinfection was 7.7%. Maximum single-drug resistance was seen in ethambutol 12 ([18.5%] 95% CI = 9.0–27.9). Conclusion: The MDR-TB rate of 3.1% found in this study was relatively low and efforts should be intensified to keep it low

Prevalence and distribution of onchocerciasis in Ahani-Achi Community, Enugu State, Nigeria

The periodic evaluation of onchocerciasis control programmes is paramount in order to ascertain the extent of realization of set goals. Therefore, the demographic pattern of infection in Ahani-Achi Community, Enugu State of Nigeria was investigated from March 2012 to April 2014. Three hundred and twenty-eight (328) participants aged 10->60 years were examined for O. volvulus infection using standard skin snip biopsy technique. Out of this number, 100 (30.49%) tested positive to O. volvulus parasitemia. Females (34.45%) were more infected than males (19.98%), although the difference was not statistically significant (p>0.05). The >60 years age-group was significantly (p<0.05) more infected in females (25.63%) than in males (10%) and farmers were significantly (p<0.05) more infected (40%) than other occupation groups. The study posits that intervention programmes in the area have been reasonably successful but efforts must be sustained towards a possible eradication of the disease.Keywords: Prevalence; distribution; river blindness (onchocerciasis); Ahani-Ach