Evaluation of current practice of antimicrobial use and clinical outcome of patients with pneumonia

Abstract

Background: Antimicrobial resistance is a major threat to public health and is driven by inappropriate antimicrobial use, which is commonly observed in the management of pneumonia. The aim of this study was therefore to assess the current practice of antimicrobial utilization and clinical outcomes in the management of adult pneumonia patients attending at Tikur Anbessa Specialized Hospital.Methods and materials: Method: A prospective observational study was conducted in a 95-bed internal medicine ward of Tikur Anbessa Specialized Hospital. Patients aged ≥14 years, with physicians' diagnosed with pneumonia were included in the study, conducted from 1 September 2016 to 30 June 2017. Chart review and self-administered questionnaires were used to collect data. Descriptive statistics and binary logistic regressions were performed for data analyses.Results: Out of 200 enrolled patients, clinical diagnosis was supported by microbiologic testing and imaging in75 (37.5%) and 122 (61.0%) cases, respectively. The treatment approach in almost all patients (99.5%) was empirical. No de-escalation therapy was made even after acquiring culture results. Vancomycin was the most commonly prescribed antimicrobial agent (25%) and about 70% of the patients had received this drug empirically. The total duration of antimicrobial therapy was 12.05 ± 5.09 days. About 30% of the patients missed their antimicrobial doses during the course of treatment and stock-outs were the major reason (36.7%). Close to 113 (66%) of the treating physicians used reference books to prescribe antimicrobial agents. Two-third (66%, 133) of the patients were stable. In-hospital mortality and complications accounted for 18.5% (37) and 17% (34), respectively. Poor clinical outcome (death and complicated cases)was found to be associated with recent antimicrobial use history (p = 0.007, AOR 2.86 (1.33-6.13)), cancer (p = 0.023, AOR 3.46 (1.18-10.13)), recent recurrent upper respiratory tract infection (p = 0.046, AOR 3.70 (1.02-13.40)), respiratory rate >24breaths/min or <12breaths/min (p = 0.013, AOR 2. 45 (1.21-4.95)) and high level of serum creatinine after initiation of antimicrobial therapy (>1.4 mg/dl) (p = 0.032, AOR 2.37 (1.07-5.20)).Conclusion: Antimicrobials are empirically prescribed without sufficient evidence of indication and microbiological or radiological findings. Besides, the practice is not based on local guidelines and no multidisciplinary approach is apparent. As a result, there were higher rates of mortality (18.5%) when compared with other similar studies.