Browsing by Author "Elias Adugna"

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    Effectiveness of Antimicrobial Stewardship Program in the Neonatal Intensive Care Unit at Tikur Anbesa Specialized Hospital, Ethiopia
    (Addis Ababa University, 2025-06-25) Elias Adugna; Getachew Alemkere; Minyahil Alebachew; Asrat Dimtse; Elham Sani
    Background: Antimicrobial stewardship programs are multifaceted interventions aimed at optimizing antibiotic use, combating antimicrobial resistance and improving patient outcomes including length of stay and mortality. Tikur Anbessa Specialized Hospital (TASH) implemented an AMS in its Neonatal Intensive Care Unit (NICU) on 3 April 2022. Objective: To evaluate the impact of Antimicrobial stewardship interventions in the Neonatal Intensive Care Unit at Tikur Anbessa Specialized Hospital, Ethiopia. Methods: A retrospective cross-sectional chart review (1, April 2021–31, March 2024) categorized into pre-intervention (1, April 2021–3, April 2022), intervention (3, April 2022–27, March 2023), and post-intervention (28, March 2023–31, March 2024) periods was conducted. Neonates treated with antibiotics for infectious diseases were included. Data on demographics, diagnostics, and antibiotic regimens were collected. Analyses included descriptive statistics, chisquare, ANOVA with Tukey post hoc tests, logistic regression (mortality predictors), and linear regression (LOS predictors), with significance set at P < 0.05. Result: A total of 763 neonates were enrolled (260 pre-AMS, 253 during AMS, 250 post-AMS). During the intervention, mean antibiotic duration decreased by 29.3% (from 10.98 ± 7.03 to 7.76 ± 6.08 days; P < 0.001), with a notable shift from broad-spectrum antibiotics (Cefotaxime, Meropenem, Cefepime, Vancomycin) to Ampicillin–Gentamicin. LOS declined by 29% (18.2 to 12.9 days; P = 0.004), and mortality halved (15.0% to 7.5%; AOR = 0.43; P = 0.011). AMS recommendations prompted discontinuation in nearly half of cases, with 94.5% acceptance. Low birth weight (<2.5 kg) doubled mortality risk (AOR = 2.01; 95% CI, 1.15–3.53; P = 0.014). Following AMS cessation, antibiotic duration rebounded by 55.4% (+5.3 days), LOS increased by 19.5% (+2.68 days), and mortality rose to 14.4%, indicating a reversion toward pre-intervention practices. Conclusion: AMS implementation in the NICU significantly optimized antibiotic use and improved clinical outcomes, reducing reliance on broad-spectrum agents, LOS, and mortality. However, cessation led to regression toward prior prescribing behavior, underscoring the necessity for sustained stewardship interventions.