# Antimicrobial use and stewardship opportunities in Burkina Faso: findings from the first Global Point Prevalence Survey in eight hospitals

## TL;DR

This study found high antimicrobial use in Burkinabe hospitals, with poor prescribing quality and a need for better stewardship to reduce misuse.

## Contribution

The first Global Point Prevalence Survey in Burkina Faso reveals AMU patterns and stewardship gaps in diverse hospital settings.

## Key findings

- 73.3% of inpatients received antimicrobials, with skin infections and pneumonia as leading indications.
- Most prescriptions were empirical, with poor documentation and limited guideline adherence.
- Tertiary hospitals used more Watch-class antibiotics, and prolonged prophylaxis was common.

## Abstract

To describe the prevalence, patterns, and quality indicators of antimicrobial use (AMU) in Burkinabe hospitals and identify priorities for stewardship.

Multicentre, cross-sectional point prevalence survey (PPS) following the Global Point Prevalence Survey protocol.

Eight public hospitals across six cities in Burkina Faso (3 primary, 3 secondary, and 2 tertiary), February–June 2019.

All inpatients present on the survey day at 8:00. Medical records were reviewed for those receiving systemic antimicrobial agents.

Standardized ward- and patient-level data were collected on indications, agents, routes, and WHO AWaRe categories, alongside quality indicators (documented indication, stop/review date, guideline compliance, and targeted vs empirical therapy). Descriptive analyses compared hospital tiers.

Of 994 inpatients, 729 (73.3%) received ≥1 antimicrobial (range by tier: tertiary 69.7%, secondary 79.2%, primary 79.2%). Community-acquired infections accounted for 96.0% of therapeutic indications. Leading reasons were skin/soft tissue infections (12.2%), gastrointestinal infections (10.7%), and pneumonia (10.4%). Parenteral administration predominated. The most used agents were ceftriaxone (27.8%), metronidazole (15.7%), and gentamicin (9.4%). By AWaRe, Access agents comprised ∼ 50%, Watch agents ∼ 50% overall, with higher Watch use in tertiary hospitals; no Reserve antibiotics were recorded. Quality indicators were suboptimal: the indication was documented in 15.6%, the stop/review date was absent in 93.0%, and 41.1% of prescriptions were guideline-compliant. Therapy was largely empirical (98.5%). Prolonged surgical prophylaxis (>1 day) represented 86.8% of prophylaxis courses.

Antimicrobial use (AMU) prevalence in Burkinabe hospitals is high, dominated by empirical therapy and Watch-class ceftriaxone. Deficits in prescribing quality and limited diagnostic use highlight urgent needs for context-adapted antimicrobial stewardship: enforce guideline-concordant care, curb prolonged prophylaxis and unnecessary Watch-class use, and expand affordable microbiology capacity to enable targeted therapy.