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Background: Antimicrobial stewardship is vital for our hospital practice but it requires a knowledge of antibiotic prescribing practices, which is currently lacking. This survey aimed to assess the antimicrobial prescribing practices in our hospital. Method: To obtain baseline information on antimicrobial prescribing practices, a uniform and standardized method for surveillance of antibiotic use in hospitals was employed. A point prevalence survey (PPS) was conducted in all the wards of the Massey Street Children’s hospital in June 2019. The PPS included all i n p a t i e n t s r e c e i v i n g a n antimicrobial on the day of survey. Data collected included age, gender, antimicrobial agents, microbiological data, and compliance to guidelines, documentation of reasons and stop/ review date of prescription. The denominator was the number of eligible patients. A web-based application developed by the University of Antwerp was used for data-entry, validation and reporting. Results: Sixty-seven children were eligible, of which 62 (92%) CC –BY 4.0 received 128 antimicrobials. Fifty- seven (85%) were on multiple antimicrobial therapies, and route of administration was parenteral in 86%. All prescriptions were empiric. Reasons for prescribing were documented in 121(94.5%) therapies in case notes; Stop/review dates were not documented in 126(98.4%). The most frequently prescribed antibiotics we r e c e f u r o x i m e ( 1 8 % ) , Ampicillin-sulbactam (15%) and gentamicin (12%). Antibiotic guidelines were not available. Most common diagnoses were sepsis (42%), pneumonia (15%) and malaria (9%). Conclusion: This survey revealed v e r y h i g h a n t i m i c r o b i a l prescribing rates in the hospital and the need to assess it appropriateness. We disclosed areas to improve antibiotic prescribing: antibiotic prescribing according to guidelines and low reporting of a stop/review date. There is a need to create awareness for evidence based antibiotic guidelines.

Background: Antimicrobial prescription becomes inappropriate when there is overprescribing, unsuitable dosage and when patients do not complete their treatments. In the outpatient settings, irrational prescription of antibiotics is more evident and has led to the development of resistance, adverse reactions, and increased health care costs. Understanding the knowledge, driving forces and practices of prescribing antibiotics is a step towards ensuring rational use of antibiotics. The study aimed to assess the knowledge, attitude, and practice of antimicrobial prescription among doctors in the outpatient departments of Lagos University Teaching Hospital Idi-Araba. Methods: This was a cross-sectional study conducted consecutively among 259 doctors in the outpatient departments of LUTH. Data entry and analysis were performed using Epi info software version 7. The level of statistical significance was at P < 0.05. Results: The mean age of the respondents was 33.5 ± 6.9 years. Majority of the respondents were males (58.7%). One-third (39%) had between 6 and 10 years of work experience. One-fifth (20.8%) of the respondents were from the department of surgery. Almost all (98.8%) had an overall good knowledge of antibiotics. Majority, (95.4%) had a good attitude towards prescribing. Two-third (63%) requested for a laboratory test before prescribing. However, less than half (44.4%) prescribed based on guidelines and more than half (56.8%) had received trainings on antibiotics prescriptions. Two-third (63.7%) of the respondents had good prescribing practices. There was a statistically significant association between the years of work experience and knowledge of prescribing antibiotics (P = 0.036). Conclusion: Majority had good knowledge and positive attitude toward prescribing. The severity of infection, availability of the drug, cost of the drug, and clinical response of the patients were the major predictors of antimicrobial prescription of the respondents. Antimicrobial stewardship programs should be enhanced and antibiotic surveillance should be improved.

Background: Multidrug‑resistant bacterial infections are still a global challenge and successful antimicrobial stewardship (AMS) requires multidisciplinary collaborative partnership. Studies have highlighted the knowledge and perceptions of pharmacists, but there is a paucity of data about practices of pharmacists in teaching hospitals in Nigeria. We set out to determine the knowledge and practices of pharmacists in a major tertiary health facility (THF) in Lagos, Nigeria, before starting an AMS intervention program. Methods: This cross‑sectional survey used electronic forms to find out the knowledge and practices of pharmacists employed in a large tertiary health facility. Data were collected during a Commonwealth Partnerships for AMS program to support low‑ and middle‑income countries to produce antimicrobial consumption surveillance data, quality improvement initiatives, and infection prevention and control (IPC) processes. Results: Two‑thirds of respondents knew that antibiotics were effective against bacteria, and 48.6% knew the causes of antimicrobial resistance. Almost all (97.1%) agreed that AMS must be done, IPC is important, and they were confident to point out inappropriate prescribing. Three‑quarters had advised colleagues or been involved in AMS activities; however, 62.9% had fully or mostly changed their practices based on information received, and 26.5% had participated in World Antibiotic Awareness Week. Conclusion: There are still gaps in knowledge and practices, which underscore the need to entrench regular training on the job. However, there is overall awareness of AMS and a desire for it to be carried out at all levels. Pharmacists are useful for choosing appropriate antibiotics and can play a vital role in AMS. [ABSTRACT FROM AUTHOR]

Objective: Vertically transmitted cytomegalovirus (CMV) is the most common cause of preventable congenital infection, including deafness and intellectual impairment worldwide. Till date, there is no consensus on routine antenatal screening worldwide. The objective of this study was to determine the prevalence of previous and primary CMV infection among antenatal women at the University of Benin Teaching Hospital (UBTH) and the effect of age, socioeconomic class, parity and gestational age on prevalence. Methods: In this descriptive cross-sectional study, blood samples were collected from each of 200 consecutive pregnant women attending the antenatal clinic of the university. Samples were analyzed for CMV specific IgG and IgM using ELISA test kits. A semi-structured researcher administered questionnaire was used to obtain socio-demographic information which included; age, socioeconomic class, parity and gestational age. Results: Seroprevalence of CMV- specific IgG and IgM were 92% and 4% respectively, while 4% were seronegative. There was no significant association between seroprevalence and any of the risk factors (p>0.05). Conclusion: There is need for voluntary screening of pregnant women as part of antenatal care to detect primary and seronegative susceptible women. J [ABSTRACT FROM AUTHOR]

Introduction: Inappropriate use of antibiotics for childhood illnesses, especially for non-bacterial infections, contributes to the development of antimicrobial resistance (AMR). Globally, implementation of antimicrobial stewardship programme (ASP) in all healthcare institutions is a strategic intervention to improve the appropriate use of antibiotics, reduce antimicrobial consumption and tackle AMR. The aim of this study was to evaluate the effect of prospective audit with intervention and feedback as an antimicrobial stewardship strategy on antimicrobial use, evaluate prescribers' response to recommendations and determine the rate of AMR in the Paediatrics Department of the Lagos University Teaching Hospital, Nigeria., Materials and Methods: This was an implementation study of the paediatrics Antimicrobial Stewardship Programme (ASP) over a period of 6 months. It was initiated with a point prevalence survey (PPS) to describe the antimicrobial prescribing patterns and followed by prospective audit with interventions and feedback using an antimicrobial checklist and the existing antimicrobial guidelines in the Paediatrics Department., Results: The antibiotic prescribing prevalence was high (79.9%) at baseline PPS with 139 patients on admission, of which 111 (79.9%) were treated with 202 antibiotic therapies. Over the 6 months of study, 582 patients on 1146 antimicrobial therapies were audited. Compliance with departmental guidelines was 58.1% of the total 1146 prescriptions audited (n = 666), making the antimicrobial prescription inappropriate in 41.9% (n = 480) of therapies. The most recommended intervention for inappropriateness was 'change antibiotics' 48.8% (n = 234), followed by 'stop antibiotics' 26% (n = 125), 'reduce the number of antibiotics' 19.6% (n = 194) and 'de-escalate' 2.4% (n = 11). Agreement with ASP interventions occurred in 193 (40.2%) cases, and the least agreed intervention was 'stop antibiotics' (n = 40, 32%). However, there was a steady increase in compliance rates with ASP interventions over the 6 months of period study, which was statically significant (χ 2: 30.005; P = 0.001)., Conclusion: ASP prospective audit with intervention and feedback was of significant benefit in improving compliance with antimicrobial guidelines, thereby improving antimicrobial therapy in the Paediatrics Department of LUTH, Nigeria.

Background: The World Health Organization Essential Medicines List (WHO-EML) includes 'access' antibiotics, judged essential to treat common infections. The European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship defined a list of 'forgotten' antibiotics, some old and often off-patent antibiotics, which have particular value for specific indications., Objective: To investigate which WHO-EML 'access' and 'forgotten' antibiotics are approved at national level in a sample of low- to middle-income countries (LMICs)., Methods: The Scientific Committee used a consensus procedure to select 26 WHO-EML 'access' and 15 'forgotten' antibiotics. Paediatric formulations were explored for 14 antibiotics. An internet-based questionnaire was circulated to 40 LMIC representatives. Antibiotics were defined as approved if an official drug regulatory agency and/or the national ministry of health licensed their use, making them, at least theoretically, available on the market., Results: Twenty-eight LMICs (11 in Africa, 11 in Asia and six in America) were surveyed. Nine WHO-EML 'access' antibiotics (amoxicillin, ampicillin, benzylpenicillin, ceftriaxone, clarithromycin, ciprofloxacin, doxycycline, gentamicin and metronidazole) were approved in all countries, and all 26 'access' antibiotics were approved in more than two-thirds of countries. Among the 15 'forgotten' antibiotics, only one was approved in more than two-thirds of countries. The median number of approved antibiotics per country was 30 (interquartile range 23-35). Six of 14 paediatric formulations (amoxicillin, amoxicillin-clavulanic acid, oral antistaphylococcal penicillin, cotrimoxazole, erythromycin and metronidazole) were approved in more than two-thirds of countries., Conclusions: WHO-EML 'access' antibiotics and the most frequently used formulations for paediatrics were approved in the vast majority of the 28 surveyed LMICs. This was not the case for many of the 'forgotten' antibiotics, despite their important role, particularly in areas with high prevalence of multi-drug-resistant bacteria., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Invasive candidiasis has been identified globally as a major cause of morbidity and mortality in neonatal intensive care units (NICU). Systemic candidiasis presents like bacterial sepsis and can involve multiple organs., Objective: The objective of this study was to determine the prevalence of Candida infection in a NICU at a tertiary hospital in Nigeria and to identify its associated risk factors., Materials and Methods: The study was a retrospective descriptive study of all cases of culture-proven invasive Candida infection (ICI) in neonates admitted to the NICU over a 4-year period. The study participants were identified from microbiology records of all neonates with a positive Candida culture. Medical records of identified neonates were also reviewed, and relevant information obtained., Results: Over the 4 years, 2712 newborns were admitted to the NICU. From these, 1182 various clinical samples were collected from babies with features of sepsis and processed in the medical microbiology laboratory. Twenty-seven (2.3%) of the cultures yielded Candida organisms; fifteen of the Candida cultures were from male infants with a male:female ratio of 1.3:1. Bloodstream infection was the most frequent ICI seen in preterm babies (seven [58.3%] out of 12 babies with ICI). Nearly, all (91.7%) affected preterm infants with ICI were <1500 g in weight. All were exposed to invasive procedures and broad-spectrum antibiotics. The case fatality rate among those with ICI was 18.5%., Conclusion: There was a significant prevalence of invasive candidiasis in high-risk newborns and the incidence increases with increased practices in risk factors such as invasive procedures and antibiotic use and lower gestational age babies with very low birth weight.

Fluconazole resistance is an important type of resistance in Candida because in most countries, fluconazole is the drug of choice for vulvovaginal candidiasis. Candida species resist fluconazole by various mechanisms but there is paucity of data on these in our environment. Such mechanisms include among others, over-expression of the ERG11 gene, which codes for synthesis of the target enzymes in the fungus. The aim of this study was to screen Candida spp. resistant to fluconazole for the expression of ERG11 gene. Fluconazole susceptibility test was performed on 28 clinical strains of Candida species previously obtained from students of a School of Nursing in Lagos, Nigeria. They were identified by API Candida, CHROMagar candida and germ tube test. Using 25 mcg discs, fluconazole susceptibility was determined by the disc diffusion method and results were interpreted in accordance with the Clinical Laboratory Standard Institute (CLSI) criteria; sensitive (S), resistant (R) and susceptible dose dependent (SDD). The R and SDD isolates were subsequently evaluated for the presence of ERG11 gene. Of the 28 clinical isolates, 14 were identified as C. albicans and six as C. tropicalis. The remaining isolates were identified as C. glabrata (2), C. famata (2) C. kefyr (2) one each of C. parapsilosis and C. guilliermondii respectively. In this study, 18 were susceptible (S) to fluconazole, eight were SDD and two were resistant to the antifungal agent. Out of the 14 C. albicans isolates, 12 were susceptible, one showed high level resistance and similar number showed susceptible dose dependence. ERG11 was detected in three susceptible dose dependent Candida species. This analysis demonstrates that susceptible dose dependence should not be overlooked as it may be associated with the presence of ERG11 gene and resistance to fluconazole. There is a need to consider routine antifungal susceptibility testing for Candida species causing vulvovaginitis.