# Point-Prevalence Survey of Antimicrobial Use in Benin Hospitals: The Need for Antimicrobial Stewardship Programs

## TL;DR

A survey in Benin hospitals found high antimicrobial use and irrational prescriptions, emphasizing the need for stewardship programs to combat resistance.

## Contribution

The study adapted a global point-prevalence survey tool for Benin hospitals and analyzed antimicrobial use with the 2021 WHO AWaRe classification.

## Key findings

- 32.9% of patients received antimicrobials, mostly orally, with high use of Access and Watch antibiotics.
- Hospital A used non-recommended antibiotic combinations, while Hospital B had suboptimal surgical prophylaxis practices.
- Prolonged antimicrobial prophylaxis was common in intensive care units, highlighting misuse risks.

## Abstract

Background: Antimicrobial resistance (AMR) is a public health concern worldwide, particularly in low-to-middle-income countries with few antimicrobial stewardship programs and few laboratories equipped for diagnosis. Methods: As point-prevalence surveys (PPSs) are a well-known tool for assessing antimicrobial use, we adjusted standardized Global-PPS for use in two hospitals in Benin and included an analysis based on the 2021 WHO AWaRe classification. Results: Of the 450 patients enrolled, 148 received antimicrobials (AMs) (overall prevalence 32.9%), most of them orally (54.2%). Both hospitals had a high rate of Access and Watch antibiotics use, and both prescribed mainly metronidazole. In four prescriptions, hospital A used a non-recommended association of antibiotics, such as ceftriaxone + sulbactam and ofloxacin + ornidazole. While hospital A prescribed predominantly amoxicillin + clavulanic acid (19/92; 21%) and ceftriaxone (14/92; 15%), hospital B prescribed ampicillin (24/120; 20%) and cefuroxime (14/120; n = 12%). In hospital B, surgical antimicrobial prophylaxis (SAP) was suboptimal. While there were no single-dose prophylaxis prescriptions, all one-day prophylaxis (SP2) involved ampicillin for cesarean sections. In patients in intensive care units, prolonged prophylaxis (>1 day, SP3) accounted for all postoperative prescriptions. Conclusions: These findings highlight the critical need for implementing antimicrobial stewardship programs, expanding diagnostic laboratory capacity to minimize empirical prescribing, and strengthening medical student training to ensure quality and rational antibiotic use, thereby addressing the growing challenge of resistance in resource-limited settings.