Poor utilization of medical microbiology laboratory by clinicians in a tertiary hospital in Lagos State Nigeria

Abstract

Background: The clinical diagnosis of infection without laboratory confirmation leads to overprescription of antimicrobials and the resultant antimicrobial resistance. Global point prevalence survey done in Lagos University Teaching Hospital showed low targeted antimicrobial therapy meaning poor utilization of Medical Microbiology laboratory for the diagnosis of infections This study is aimed at finding the reasons for poor utilization of the Medical Microbiology laboratory for the diagnosis of infections
Methods: A cross sectional survey of clinicians in Lagos University Teaching Hospital was conducted using self-administered structured questionnaire to obtain information on utilization of the medical microbiology laboratory for diagnosis of infections.
Result: Two hundred and four doctors from various departments responded to our questionnaire amongst whom were: houseofficers (13.7%), junior registrars (36.3%), senior registrars (34.3%), consultant (11.3%) and medical officers (4.4%). The years of practice were: 1 – 10years (77.3%), 11 – 20 years (14.8%), 21 – 30 years (4.4%), >30 years (3.5%). One hundred and forty four participants (70.6%) reported good use of Microbiology laboratory for the diagnosis of infection. Of 60 participants (29.4%) that reported poor use of Medical Microbiology laboratory, only 41 gave reasons. The main reason for poor utilization was that “Clinical diagnosis is sufficient” (56.1%), followed by” Results are often delayed and end up being irrelevant to patient management” (22.0%). Only 7.3% reported that their reason for poor use of the Microbiology laboratory was that their patient cannot afford the cost. Other reasons were: 'No access to Medical Microbiology Laboratory” (4.9%), 'No confidence in the accuracy of laboratory result” (4.9%) “Already know potent antibiotics, so there's no need for laboratory test”. None of the participants gave the following reasons: “No pathologist to ensure the quality of laboratory services” and “Don't need Medical Microbiology laboratory to manage patients with infection”. Microscopy, culture and sensitivity was the investigation most often requested for (63.7%) participants) while antigen detection was the Two hundred and four doctors from various departments responded to our questionnaire amongst whom were: house least (6.4 %) participants. Of all the variables assessed, only being a senior registrar was associated with good use of medical microbiology laboratory.
Conclusion:This result showed poor utilization of the laboratory (29.2%) and the main reason for this poor utilization is the presumption by prescribers that clinical diagnosis is sufficient for the diagnosis of infection (56.1%). Prescribers should be educated on the use of the Medical Microbiology for targeted antimicrobial therapy.