Evaluation of current practice of antimicrobial use and clinical outcome in the management of pneumonia among pediatric patients admitted to Jimma Medical Center, Southwest Ethiopia: a prospective observational study.

Abstract

Background: Inappropriate use of antibiotics is one of the major contributing factors for the development of antibiotic resistance, threatening the effective prevention and treatment of common infections. Appropriate antimicrobial use is the cornerstone for curbing antimicrobial resistance and achieving good clinical and economic outcomes. The issues of appropriate antimicrobial use are of critical importance to the global community.

Objectives: To evaluate the current practices of antimicrobial utilization and outcomes in the management of Pneumonia among pediatric patients admitted to the hospital.

Method: A prospective observational study design was conducted on children admitted to the pediatric wards of the hospital. The study was conducted from 3 February 2022 to 3 June 2022, and patients aged <18 years and diagnosed with pneumonia were included. A chart review supplemented by a self-administered questionnaire was used to collect data. Descriptive statistics and binary logistic regressions were performed for data analyses.

Results: Among the total of 146 patients, 61.6% were male, and the mean age was 40.95 (+47.61) months. Treatment approaches in all were empirical and no de-escalation therapy was made even after culture results. Ceftriaxone was the most commonly prescribed antimicrobial. Patients' outcomes included a clinical cure rate of 65.1%, an in-hospital mortality rate of 7.5%, and a complication rate of 27.3%. Poor clinical outcome was associated with recent antimicrobial use (AOR = 3.87; 95% CI:1.34-11.16; P = 0.012), antimicrobial changed (AOR = 3.74; 95% CI: 1.522-9.22; P = 0.004), and longer hospital stay (>10 days) (AOR = 6.00; 95% CI: 2.53-14.22; P = 0.029) were all independent predictors of poor clinical outcome in treatment of pneumonia.

Conclusion: Antimicrobials were prescribed empirically without sufficient evidence of indication such as microbiological and radiologic findings. The practice also is not based on local guidelines and has no multidisciplinary approach in management. These factors likely contributed to higher rates of poor outcomes (more than one-fourth of the patients) when compared with similar studies in other countries. Therefore, these observations need the hospital's establishment of an antimicrobial stewardship program centered on fundamental strategies in pediatrics, including preauthorization, prospective audits with feedback, and pharmacist-led interventions that are feasible and accepted in the inpatient setting as soon as possible.