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Effect of Hospital Antimicrobial Resistance Surveillance on Antibiotic Prescribing Practices in Nigeria

Abstract

Antimicrobial resistance is an increasing public health challenge that threatens the effective treatment of bacterial infections and may contribute to prolonged illness, increased healthcare costs, extended hospital stays, treatment failure, and preventable mortality. Appropriate antibiotic prescribing is essential for limiting the emergence and spread of antimicrobial resistance, yet antibiotic prescribing practices in Nigerian hospitals may be influenced by empirical prescribing, limited access to laboratory results, inadequate antimicrobial stewardship, prescriber workload, availability of antibiotics, patient expectations, and insufficient information on local resistance patterns. Hospital antimicrobial resistance surveillance provides systematic information on the occurrence, distribution, and susceptibility patterns of resistant microorganisms and can support healthcare professionals in selecting appropriate antibiotics. Effective use of antimicrobial resistance surveillance information may improve evidence-based prescribing and promote more rational antibiotic use in hospitals. Against this background, this study investigates the effect of hospital antimicrobial resistance surveillance on antibiotic prescribing practices in Nigeria. The study will be anchored on the Health Belief Model, the Donabedian Model of Healthcare Quality, and Systems Theory. The Health Belief Model explains how healthcare professionals' perceptions of the risks and consequences of antimicrobial resistance, perceived benefits of appropriate antibiotic prescribing, perceived barriers, and cues to action may influence prescribing decisions. The Donabedian Model explains healthcare quality through structure, process, and outcome, with antimicrobial resistance surveillance representing an important healthcare information process and antibiotic prescribing practices serving as a measurable outcome. Systems Theory views antimicrobial resistance surveillance as an interconnected hospital system involving clinicians, pharmacists, microbiology laboratories, infection prevention and control teams, hospital management, patients, and antimicrobial stewardship structures. Collectively, these theoretical perspectives provide a suitable framework for explaining how antimicrobial resistance surveillance may influence antibiotic prescribing practices in Nigerian hospitals. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise medical doctors and other healthcare professionals involved in antibiotic prescribing in selected public and private hospitals in Nigeria, together with relevant microbiology, pharmacy, antimicrobial stewardship, and prescribing records. A multistage sampling technique will be used to select states, local government areas, hospitals, clinical departments, healthcare professionals, and eligible prescription records. Hospital antimicrobial resistance surveillance will be assessed using indicators such as availability of microbiology laboratories, routine antimicrobial susceptibility testing, surveillance of resistant organisms, availability of local antimicrobial resistance data, frequency of surveillance reporting, accessibility of resistance reports to prescribers, electronic surveillance systems where available, laboratory-clinical communication, antimicrobial stewardship participation, surveillance training, feedback mechanisms, and use of antibiograms or facility-specific resistance profiles. Antibiotic prescribing practices will be assessed using indicators such as appropriate antibiotic selection, adherence to treatment guidelines, use of microbiological evidence where available, correct dosage, appropriate route of administration, appropriate treatment duration, de-escalation or modification based on laboratory results, avoidance of unnecessary antibiotics, appropriate prophylactic antibiotic use, documentation of prescribing decisions, and use of restricted antibiotics. Data will be collected using structured questionnaires, antibiotic prescription records, microbiology laboratory records, antimicrobial susceptibility reports, hospital antibiograms, antimicrobial stewardship reports, pharmacy records, medical records, and relevant hospital documents. Descriptive statistics will be used to summarize healthcare professionals' characteristics, antimicrobial resistance surveillance activities, resistance patterns, and antibiotic prescribing practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of antimicrobial resistance surveillance on antibiotic prescribing practices. Where a quasi-experimental design is adopted, prescribing practices before and after implementation of an enhanced antimicrobial resistance surveillance system may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that effective hospital antimicrobial resistance surveillance has a significant positive effect on antibiotic prescribing practices in Nigeria. Healthcare facilities with functional antimicrobial resistance surveillance systems are expected to demonstrate greater adherence to antibiotic prescribing guidelines, more appropriate antibiotic selection, improved adjustment of empirical therapy based on susceptibility results, and reduced unnecessary use of broad-spectrum antibiotics. Regular dissemination of local resistance data and antibiograms may enable prescribers to make more informed empirical treatment decisions and recognize changing resistance patterns. Collaboration among clinicians, pharmacists, microbiologists, infection prevention personnel, and antimicrobial stewardship teams is also expected to strengthen the use of surveillance information in prescribing decisions. However, inadequate laboratory capacity, delayed susceptibility results, limited access to local resistance data, shortages of trained personnel, poor communication between laboratories and clinicians, insufficient funding, and inconsistent antimicrobial stewardship implementation may reduce the effectiveness of surveillance systems. The study therefore expects timely, reliable, accessible, and well-integrated antimicrobial resistance surveillance to contribute significantly to improved antibiotic prescribing practices in Nigerian hospitals. The study is expected to contribute to the literature on antimicrobial resistance surveillance, antibiotic prescribing practices, antimicrobial stewardship, hospital microbiology, infection prevention and control, rational antibiotic use, patient safety, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Nigeria Centre for Disease Control and Prevention, state ministries of health, hospital management boards, microbiology laboratories, pharmacists, physicians, infection prevention and control committees, antimicrobial stewardship teams, professional regulatory bodies, development partners, and policymakers regarding strategies for strengthening antimicrobial resistance surveillance and promoting appropriate antibiotic use. The study will also provide evidence-based recommendations for strengthening hospital microbiology laboratories, improving antimicrobial susceptibility testing, developing and regularly updating facility-specific antibiograms, ensuring timely dissemination of resistance data to prescribers, strengthening antimicrobial stewardship programmes, improving laboratory-clinical communication, training healthcare professionals, and integrating antimicrobial resistance surveillance into hospital quality-improvement and antibiotic-prescribing policies across Nigeria.

Keywords: Antimicrobial resistance surveillance, antibiotic prescribing practices, antimicrobial stewardship, antibiotic use, antimicrobial susceptibility testing, hospital microbiology, rational prescribing, infection prevention and control, patient safety, Nigeria, public health.