Evaluation of current practice of antimicrobial use and clinical outcome of patients with pneumonia at a tertiary care hospital in Ethiopia: A prospective observational study

Fenta, Theodros; Engidawork, Ephrem; Amogne, Wondwossen; Berha, Alemseged Beyene

doi:10.1371/journal.pone.0227736

Cited by 11 publications

(26 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding, however, was consistent with studies done in Spain, Portuguese, and Egypt. 29–31 The finding in this study was higher than from the finding from the study conducted previously in Ethiopia 22 and the possible explanation is that this study included critical patients admitted to ICU admissions in addition to ward admitted patients, who have better outcome comparatively.…”

Section: Discussioncontrasting

confidence: 60%

See 1 more Smart Citation

Outcomes and Predictors of Severe Community-acquired Pneumonia Among Adults Admitted to the University of Gondar Comprehensive Specialized Hospital: A Prospective Follow-up Study

Kassaw¹,

Mohammed²,

Tessema³

et al. 2023

IDR

View full text Add to dashboard Cite

Background Severe community-acquired pneumonia is a common life-threatening infection with a high rate of unfavorable outcome. This study aimed to assess the outcomes and predictors of hospitalized severe community-acquired pneumonia patients at University of Gondar comprehensive specialized hospital. Methods A prospective follow-up study was conducted at University of Gondar comprehensive specialized hospital from May 1 to September 31, 2021. The data was collected by reviewing patients’ charts and interviewing the patients themselves. Descriptive statistics, binary and multivariable logistic regression analysis were performed accordingly. Variables with p -value <0.2 on binary logistic regression were analyzed using multivariable logistic regression and variables with p <0.05 were considered to have significant association. Results A total of 239 admitted patients with severe community-acquired pneumonia were enrolled in the study. An unfavorable outcome was observed in 105 (44%) patients; 24.27% was in-hospital all-cause mortality, 12.5% was nonresolution, 5.8% was complicated cases, and 1.26% were gone against medical care for poor prognosis. After analyzing multivariable logistic regression, confusion (OR= 4.84; 95%CI: 1.47–15.88), anemia (OR= 2.36; 95%CI: 1.01–5.52), leukopenia (OR=4.38; 95%CI: 1.26–15.25), leukocytosis (OR=3.15; 95%CI: 1.23–7.96), elevated creatinine (OR=5.67; 95%CI: 1.72–18.65), intubation (OR=7.27; 95%CI: 1.58–33.37) and antibiotic revision during treatment for a different reason (OR=0.02; 95%CI: 0.01–0.07) were variables significantly associated with unfavorable outcome. Conclusion Unfavorable outcome was high among hospitalized severe community acquired pneumonia patients, and confusion, elevated creatinine, anemia, leukopenia, leukocytosis, intubation during admission, and antibiotic revision during the course were independent predictors associated significantly with the unfavorable outcome. It is important to consider the development of a treatment protocol for the hospital and to further research incorporating the microbiologic profile of the patients.

show abstract

Section: Discussioncontrasting

confidence: 60%

“…By considering 95% confidence level, 5% margin of error (d), and by taking 18% proportion (P) of unfavorable outcome of SCAP from previous study. 22 By assuming the above assumptions, the required sample size (n) was calculated using the formula . By adding a 5% of nonresponse rate, the final sample size was 239.…”

Section: Methodsmentioning

confidence: 99%

Outcomes and Predictors of Severe Community-acquired Pneumonia Among Adults Admitted to the University of Gondar Comprehensive Specialized Hospital: A Prospective Follow-up Study

Kassaw¹,

Mohammed²,

Tessema³

et al. 2023

IDR

View full text Add to dashboard Cite

show abstract

“…In the current study, 15.2% of the study participants had taken carbapenems prior to recruitment to the study (see Table S1 ). Empirical prescription of carbapenems, particularly meropenem, was very common in the hospital [ 26 ], which may have created resistance and furthered the emergence of carbapenemase-producing bacteria.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Multidrug-Resistant Klebsiella pneumoniae in a Tertiary Care Hospital in Ethiopia

et al. 2021

View full text Add to dashboard Cite

Klebsiella pneumoniae poses an urgent public health threat, causing nosocomial outbreaks in different continents. It has been observed to develop resistance to antimicrobials more easily than most bacteria. These days, multidrug-resistant strains are being increasingly reported from different countries. However, studies on the surveillance of multidrug-resistant Klebsiella pneumoniae are very rare in Ethiopia. This study aimed to determine the antimicrobial resistance patterns and magnitude of MDR K. pneumoniae isolates from patients attending or admitted to Tikur Anbessa Specialized Hospital (TASH). A cross-sectional study was conducted from September 2018 to February 2019 at TASH, Addis Ababa, Ethiopia. Identification of K. pneumoniae was done by examining the Gram stain, colony characteristics on MacConkey agar and 5% sheep blood agar, as well as using a series of biochemical tests. Antimicrobial susceptibility testing of the isolates for 21 antimicrobials was done by the Kirby–Bauer disc diffusion technique. Data were double entered using Epidata 3.1 and exported to SPSS version 25 software for analysis. Among the total K. pneumoniae isolates (n = 132), almost all 130 (98.5%) were MDR. Two (1.5%) isolates showed complete non-susceptibility to all antimicrobial agents tested. Moreover, a high rate of resistance was observed to cefotaxime and ceftriaxone 128 (97%), trimethoprim-sulfamethoxazole 124 (93.9%), and cefepime 111 (84.1%). High susceptibility was recorded to amikacin 123 (93.2%), imipenem 107 (81.1%), meropenem 96 (72.7%), and ertapenem 93 (70.5%). K. pneumoniae isolates showed a high rate of resistance to most of the tested antimicrobials. The magnitude of MDR K. pneumoniae was very alarming. Therefore, strengthening antimicrobial stewardship programs and antimicrobial surveillance practices is strongly recommended in TASH.

show abstract

“…Nevertheless, it is higher than a study from Tunisian and Libyan hospitals (11.4%) [ 21 ]. Empirical prescription of carbapenems particularly meropenem was very common in the hospital where we did the current study [ 22 ] and also in another study by Gebretekle et al a significant amount (38.6%) of meropenem was prescribed when it was not needed [ 23 ]. Additionally, in this study, previous carbapenem use has an association with carbapenemase production.…”

Section: Discussionmentioning

confidence: 90%

Detection of blaKPC and blaNDM carbapenemase genes among Klebsiella pneumoniae isolates in Addis Ababa, Ethiopia: Dominance of blaNDM

et al. 2022

View full text Add to dashboard Cite

Background Infections caused by Klebsiella pneumoniae have been difficult to control because of the worldwide emergence of carbapenem-resistant isolates mainly due to carbapenemase production. Information regarding carbapenemase-producing K. pneumoniae is still scarce in Ethiopia. Therefore, the current study aimed to determine the prevalence of carbapenemase-producing K. pneumoniae and to assess the occurrence of blaNDM and blaKPC carbapenemase genes. Methods A cross-sectional study was conducted from September 2018 to February 2019 at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A total of 132 non-duplicate K. pneumoniae isolates were studied. Phenotypic confirmation of carbapenemase production was done by modified Carbapenem Inactivation Method (mCIM). Multiplex PCR was performed for the detection of carbapenemase-encoding genes blaKPC, and blaNDM. Results Out of the total 132 K. pneumoniae isolates, 39 (29.6%) were non-susceptible to one or more carbapenems. The prevalence of carbapenemase-producing isolates from the total was 28 (21.2%) with mCIM of which the most dominant gene was blaNDM 26 (92.9%) and one isolate carried blaKPC concomitantly. Carbapenemase-producing K. pneumoniae isolates were 100% non-susceptible to half of the antimicrobials used in the study, including meropenem and ertapenem. Previous use of carbapenems was associated with carbapenemase production (P = 0.004). Conclusions The prevalence of carbapenemase-producing K. pneumoniae isolates was worrying in the study area. To our knowledge, the study described the emergence of blaNDM and blaKPC gene carrying K. pneumoniae in Ethiopia for the first time. Further large-scale molecular-based studies, including other carbapenemase genes and sequencing of K. pneumoniae, are warranted to have a clear awareness about the presence of antimicrobial resistance high-risk clones in Ethiopia.

show abstract

Evaluation of current practice of antimicrobial use and clinical outcome of patients with pneumonia at a tertiary care hospital in Ethiopia: A prospective observational study

Cited by 11 publications

References 38 publications

Outcomes and Predictors of Severe Community-acquired Pneumonia Among Adults Admitted to the University of Gondar Comprehensive Specialized Hospital: A Prospective Follow-up Study

Outcomes and Predictors of Severe Community-acquired Pneumonia Among Adults Admitted to the University of Gondar Comprehensive Specialized Hospital: A Prospective Follow-up Study

High Prevalence of Multidrug-Resistant Klebsiella pneumoniae in a Tertiary Care Hospital in Ethiopia

Detection of blaKPC and blaNDM carbapenemase genes among Klebsiella pneumoniae isolates in Addis Ababa, Ethiopia: Dominance of blaNDM

Contact Info

Product

Resources

About