APPROPRIATENESS, OUTCOMES OF ANTIMICROBIAL TREATMENTS AND ASSOCIATED FACTORS AMONG PATIENTS WITH PNEUMONIA IN MEDICAL AND PEDIATRIC WARDS OF PUBLIC HOSPITALS IN HARAR, EASTERN ETHIOPIA: A RETROSPECTIVE CHART REVIEW

Abstract

Pneumonia is the leading cause of morbidity and mortality among all age groups throughout the world, especially in low and middle-income countries. The empiric approach of treating hospitalized patients with pneumonia is common in our country despite the high prevalence of drug-resistant pathogens. In this respect, it is inevitable to know the appropriateness and outcomes of antimicrobial treatments for patients with pneumonia. Objective: To assess appropriateness, outcomes of antimicrobial treatments, and associated factors among patients with pneumonia at medical and pediatric wards of Hiwot Fana Specialized University Hospital and Jugal Hospital from May 1-31, 2021. Method and Materials: A retrospective cross-sectional study was conducted among 693 patients with pneumonia admitted to medical and pediatric wards of Hiwot Fana Specialized University Hospital and Jugal Hospital from May 1-31, 2021. Data were extracted from patient medical record cards. Then, entered into EpiData version 3.1 and analyzed with SPSS version 26. Bivariable and multivariable logistic regression was run to identify factors associated with unfavorable treatment outcome. The model goodness of fit was checked by the Hosmer-Lemeshow statistic test. Association was described using adjusted odds ratio along with 95% confidence interval and P value <0.05 was considered as a statistically significant association. Results: From a total of 693 patients included, 88 (12.7%, 95%, CI:10.2-15.2) of them had unfavorable treatment outcome. Ceftriaxone plus azithromycin followed by ceftriaxone alone were the most commonly used antimicrobials in the treatment of pneumonia. A total of 116 (16.74%) of patients had received initial inappropriate treatments. Patients with comorbidity (AOR=2.96; 95%, CI:1.47-5.97), abnormal body temperature (AOR=4.03; 95%, CI:2.14-7.58), tachycardia (AOR=2.57; 95%, CI:1.45-4.55), bradypnea or tachypnea (AOR=3.92; 95%, CI:1.94-7.92), oxygen saturation < 90% (AOR=2.52; 95%, CI:1.37-4.64), leukocytosis (AOR=2.78, 95%, CI:1.38-5.58), and initial inappropriate treatments (AOR=4.30; 95%, CI:2.33-7.94) were significantly associated with unfavorable treatment outcome. Conclusion: More than one in ten patients and one in five patients had unfavorable treatment outcome and received initial inappropriate treatments respectively. Hence, adherence to the recommendation of guidelines and giving special attention to patients with comorbidity and abnormal vital signs can help for optimal treatment of patients with pneumonia