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Trends in Antibiotic Use among Cardiovascular Heart Disease Inpatients at the Jakaya Kikwete Cardiac Institute in Tanzania from 2016 to 2022

Article scientifique 2025 Anglais

Résumé

Abstract Objective To analyse trends in antibiotic use among cardiovascular inpatients at the Jakaya Kikwete Cardiac Institute (JKCI), Tanzania, from 2016 to 2022, using the World Health Organisation (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology. Design Retrospective longitudinal study. Setting Jakaya Kikwete Cardiac Institute, a 150-bed national referral and teaching hospital in Dar es Salaam, Tanzania. Patients 11,656 cardiovascular inpatients; 6,612 (56.7%) received at least one systemic antibiotic. Methods Prescription data (250,591 total; 30,885 antibiotic-related) were extracted from the JKCI MedPro dispensing system. Antibiotic use was expressed in Defined Daily Doses per 100 bed-days (DDD/100). Analyses were conducted using Microsoft Excel, SPSS version 26, and time-series forecasting with AutoRegressive Integrated Moving Average (ARIMA) modelling in R. Results Overall, antibiotic use was 29.88 DDD/100 bed-days. Injections accounted for more than 55% of use. At the ATC Class 4 level, carbapenems (J01DH) dominated (45.6%), followed by third-generation cephalosporins (17.0%) and extended-spectrum penicillins (14.6%). At the molecular level, meropenem contributed 45.6%, with amoxicillin and ceftriaxone also being prominent; the top 11 antibiotics comprised more than 90% of total use (Drug Utilisation 90% [DU90%]). By WHO Access, Watch, Reserve (AWaRe) classification, Reserve agents contributed 46.4% of use, followed by Watch (31.3%) and Access (21.1%). ARIMA (1,1,0) modelling forecasts a continued upward trend through 2026. Conclusions Antibiotic use among cardiovascular inpatients at JKCI is high, with heavy reliance on broad-spectrum and Reserve agents. Strengthened antimicrobial stewardship measures, such as intravenous-to-oral switch protocols, DU90 audits, and stricter control of Reserve antibiotic prescribing, are urgently needed to mitigate antimicrobial resistance risks.

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Ndayomwami, J., Mwamelo, J., Kaniki, H., Mwakyomo, J., Majani, N., Mutagaywa, R., Kisenge, P., Janabi, M., Sangeda, R. (2025). Trends in Antibiotic Use among Cardiovascular Heart Disease Inpatients at the Jakaya Kikwete Cardiac Institute in Tanzania from 2016 to 2022. https://doi.org/10.1101/2025.09.24.25336595

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Auteur(s)

Jackob Aron Ndayomwami Judith Ambele Mwamelo Hamis Abdalla Kaniki James Mwakyomo Naizihijwa Majani Reuben Mutagaywa Peter Kisenge Mohamed Janabi Raphael Zozimus Sangeda

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