Antibiotic Use Practice and Predictors of Hospital Outcome Among Patients with Systemic Bacterial Infection at Tikur Anbessa Specialized Hospital: Identifying Targets for Antibiotic and Health Care Resource Stewardship
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Date
2015-04
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Addis Ababa University
Abstract
Background: Despite massively used in different settings, about half of antimicrobial agents prescribed to hospital in-patients were considered inappropriate. Such malpractice and excess use has been associated with increased mortality, adverse drug reactions, financial cost and the development of resistant bacteria, which have become a threat for the generation. These calls for an integrated intervention that should better are preceded with identification of targets.
Objective: To assess the antibiotic use practice and to identify predictors of hospital outcome among patients with systemic bacterial infection to uncover targets for antibiotic and health care resource stewardship
Methods: A prospective cross-sectional study was performed from 9 April to 7 July in the internal medicine wards of Tikur Anbessa specialized Hospital. Patients who had and/or developed systemic bacterial infections during this period were strictly followed. Data abstraction format was used to collect data on demographic, disease, drug and microbiologic related factors. Pattern of antibiotic use was assessed and predictors for mortality and length of stay (LoS) were identified. Descriptive statistics and Binary logistic regression were used for statistical analysis.
Results: Females accounted for about 52% of the 323 study participants whose mean age was 41.8. Of all, 75.2% of the participants had suspected infection during ward admission. Cephalosporins were the most widely prescribed class of drugs in the internal medicine wards and the medical ICU. Based on changes to microbiologic culture reports the initial antibiotic uses were inappropriate in all of the ICU and 99.3% of the ward patients. About 28% of the wards and 59% of the ICU patients were died during the in-hospital stay. The mean (+ SD) LoS was 18.5+12.2 in the wards and 8.9+4.9 days in the ICU. Whilst presence of HIV, liver-cirrhosis, different signs and symptoms of disease, neoplasm, sepsis, meningitis, renal failure, vancomycin and increased antibiotic courses (> 2) were
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positive predictors, prolonged antibiotic days (>10) and simultaneous antibiotic uses (>3) were negative predictors of mortality. On the other hand, age range of 25-44, hospital acquired infection and prolonged agent days (>21) (positively) and on admission infection (negatively) were independently associated with prolonged LoS.
Conclusion: Generally, these observations call for the establishment and implementation of antimicrobial stewardship that facilitate appropriate use of antimicrobials as a whole in the context of resource limited settings. Any stewardship activity should better start by addressing infections like pulmonary, sepsis and meningitis and drugs like vancomycin.
Key words: Antimicrobial Stewardship, Antibiotic use, Length of Stay, In-hospital Mortality, Tikure Anbesa Specialized Hospital, Ethiopia
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Keywords
Antimicrobial Stewardship; Antibiotic use; Length of Stay; In-hospital Mortality; Tikure Anbesa Specialized Hospital, Ethiopia