Published in PLOS One on 2026-07-24, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Fiona Mutesi Magololo, Dathan Byonanebye, Flavia Dhikusooka, Adelline Twimukye, Doreen Agaba, Ellon Twinomuhwezi, Hope Mackline, Edith Namakula, Alex Emmanuel Elobu, Norbert Orwotho Tholith, Francis Kakooza, Andrew Kambugu, Henry Kajumbula
Source: PLOS One • DOI 10.1371/journal.pone.0352983
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Inappropriate antibiotic use in surgical wards is a major driver of antimicrobial resistance (AMR), especially in low- and middle-income countries, where empirical prescribing is common. This study assessed inpatient antibiotic use and AMR patterns, integrating these findings with qualitative in-depth interviews (IDIs) which explored determinants of prescribing practices.
A convergent mixed methods study design was employed on the surgical wards of Mulago National Referral Hospital (MNRH) in Uganda. Quantitative data was collected through Point Prevalence Surveys (PPS) of antibiotic use and retrospective analysis of routine laboratory AMR data. Qualitative data was obtained through IDIs with healthcare workers (HCWs). Quantitative data was analysed using R version 4.2.2 and STATA 19. In-depth interviews were recorded and transcribed verbatim, open coded and then analysed using NVivo 12.
Of 303 total surgical inpatients, 193/303 (63.7%) (95% CI: 58.0–69.12) were receiving at least one of the 281 antibiotic prescriptions and were included in this study. Surgical antibiotic prophylaxis (SAP) accounted for 256/281 (91.1%) of all antibiotic prescriptions, with 239/256 (93.4%) SAP extending beyond the first 24 hours. Ceftriaxone 89/281 (31.7%) (95% CI: 26.27–37.46), metronidazole 66/281 (23.5%) (95% CI: 18.66–28.89) and levofloxacin 24/281 (8.5%) (95% CI: 11.61–20.44) were most prescribed antibiotic agents. Watch category antibiotics were most used 152/281 (54.1%) (95%: 48.08–60.08), followed by Access category 129/281 (45.9%) (95% CI: 39.9–51.9). Although HCWs demonstrated awareness of AMS principles, formal stewardship systems were fragmented, and prescribing behaviour was strongly influenced by laboratory constraints, infection prevention and control (IPC) gaps and systemic challenges.
Prolonged SAP and Watch category predominant prescribing occur within a context of high AMR prevalence and constrained AMS infrastructure. Integrated AMS interventions combining institutional antibiograms and their reinforcement, audit and feedback mechanisms, establishment of clear AMS structures and laboratory capacity strengthening are urgently needed to mitigate AMR and optimize surgical antibiotic use.
Introduction
Antimicrobial resistance (AMR) is a growing global public health challenge, disproportionately affecting low- and middle-income countries (LMICs). In Africa, where the burden of surgical site infections is over 40%, AMR is estimated to contribute to at least one million deaths per annum [1–3]. In Uganda, hospital surveillance data shows resistance as high as 44% to 100% for many first line antibiotics, contributing to treatment failure, prolonged hospitalization and higher morbidity and mortality [4,5]. Surgical wards represent high-risk settings for AMR, due to high antibiotic exposure for perioperative surgical antibiotic prophylaxis (SAP) and empirical therapy, often in contexts of limited microbiological guidance and inadequate infection prevention and control (IPC) practices [6,7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Fiona Mutesi Magololo, Dathan Byonanebye, Flavia Dhikusooka, Adelline Twimukye, Doreen Agaba, Ellon Twinomuhwezi, Hope Mackline, Edith Namakula, Alex Emmanuel Elobu, Norbert Orwotho Tholith, Francis Kakooza, Andrew Kambugu, Henry Kajumbula. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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- Evidence brief: Compliance with infection prevention and control practices and associated factors among healthcare workers in Tanzania: Experience from a secondary level-referral hospital
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- Evidence brief: Prevalence of antimicrobial resistance in Tanzania: A systematic review and meta-analysis
