Antibiotic use and resistance pattern at Rumphi District Hospital in Malawi: a retrospective study

Abstract

Abstract Background Overuse of antibiotics is a key driver of antimicrobial resistance (AMR) world-wide. Malawi continues to report rising cases of AMR among both in-patients and out-patients. We investigated antibiotic use and resistance trends at Rumphi District Hospital, Malawi. Methods We used a retrospective study design where data records on antibiotic resistance pattern alongside patient antibiotic history were extracted retrospectively from microbiological register from 2019 to March, 2023. We also included the findings of Point prevalence survey (PPS) on antibiotic use for the same facility previously conducted in 4 hospital wards using modified Global-PPS data collection tools. Document collection exercise was carried by a well-trained multi-disciplinary team. Data analysis was done using STATA 14 and Microsoft excel. Results were presented in tables and bar charts. Results Findings on antibiotic use for 80 patients enrolled in PPS revealed Ceftriaxone (54.3%) and Metronidazole (23.3%) as the most frequently used antibiotics in the wards which were prescribed empirically (100%) without a microbiological indication. A total of 85 patients’ data records were reviewed on antibiotics resistance pattern in which 54 (63.5%) were females. Patient antibiotic history captured indicated Metronidazole (23%), Gentamycin (20%) and Doxycycline (23%) as the most frequently used antibiotics among clients referred for microbiological investigations. Chloramphenicol (58% versus 61%, P = 0.6) exhibited an increase effectiveness while Gentamycin (47% versus 15%, P = 0.38) had a substantial increase in resistance. Neisseria gonorrhoeae (23%) and candida sp (15%) were the frequently isolated genital-pathogens while Staphylococcus sp (16%) dominated in wound pus samples. Conclusion Observed increased in antibiotics resistance patterns provide evidence of a rise in Multi-Drug Resistant infections against limited therapeutic options. The findings underline the need for strengthening antimicrobial stewardship programmes such as AMR surveillance and rotation of antibiotics to preserve them for a longer use.