Underutilization of the Clinical Microbiology Laboratory by Physicians in Nigeria

Abstract

Background: Clinical laboratories are critical to correct diagnosis of medical conditions to ensure appropriate management. Point prevalence survey (PPS) of antimicrobial use and resistance performed in Nigeria in 2015 and 2017 showed high rates of antibiotic use, but poor laboratory utilization for definitive diagnosis of the infections for which the antimicrobials were prescribed. This study investigated the reasons for clinicians‟ poor utilization of the clinical laboratory for definitive diagnosis and treatment of infections.

Methods: A cross sectional survey of clinicians attending the 2018 annual scientific conference and general meeting of the National Postgraduate Medical College of Nigeria (NPMCN) in Owerri, Southeastern Nigeria, was conducted using self-administered structured questionnaire to obtain information on the sub-optimal utilization of the clinical microbiology laboratory.

Results: Of 283 respondents, 14.8% were general practitioners and 85.2% were specialists who have been in practice for a median period of 20 years (range 3 – 48 years). The specialists included surgeons (26%), family physicians (19.8%), internists (14.3%), pathologists (13.9%), paediatricians (8.8%), obstetricians and gynecologists (8.1%), community medicine physicians (6.2%), and dental surgeons (2.6%). Majority of the respondents (90.8%) work in public, 88.3% work in tertiary and 9.9% in secondary care hospitals. For diagnosis of infections, 16% and 49.8% reported using laboratory “always” and “very often” respectively. Among these, the most commonly utilized investigations were microscopy, culture and sensitivity (62.4%), DNA detection (18.3%), GeneXpert for tuberculosis (17.2%), and antigen detection (16.7%). Among clinicians that “hardly make use” of the laboratory, their reasons for non-use were; clinical diagnosis being sufficient (39.7%), delayed results (17.2%), having knowledge of „potent‟ antibiotics (15.5%), lack of access to microbiology laboratory (13.8%), absence of pathologists to assure quality of tests (12.1%), and no need of the laboratory to manage patients with infections (8.6%).

Conclusion: These findings indicate that poor use of the microbiology laboratory seems mainly associated with perception and attitude of the physicians to the relevance of the laboratory, and perceived inadequacy of microbiology practice in some others. There is need to raise physicians‟ awareness on the relevance and what constitutes optimal use of the clinical microbiology laboratory for accurate diagnosis of infections and appropriate antimicrobial use.

Key words: utilization, microbiology laboratory, diagnosis, antimicrobials, infectious diseases