dc.contributor.author | Ligogo, Babra L | |
dc.date.accessioned | 2021-01-26T08:04:23Z | |
dc.date.available | 2021-01-26T08:04:23Z | |
dc.date.issued | 2020 | |
dc.identifier.uri | http://erepository.uonbi.ac.ke/handle/11295/154177 | |
dc.description.abstract | Background: Studies have postulated that approximately a third of the antibiotic use
worldwide is irrational, posing a major global challenge to containment of drug-resistant
infections. In the critical care units, irrational antibiotic use is associated with high
mortality rates. In Kenya, there is scarce data on rational use of antibiotics within critical
care units and its impact on patient clinical outcomes.
Study Objective and Setting: This study sought to evaluate rational use of antibiotics
among patients admitted to various Critical Care Units at Kenyatta National Hospital
(KNH) and its impact on clinical outcomes.
Methods: A retrospective cross-sectional study was conducted by reviewing 220 eligible
patient medical records from various Critical Care Units at the Kenyatta National Hospital.
Patients were recruited by stratified proportionate sampling depending on the admission
capacity of each unit. The data extracted into predesigned tool included patient
demographics, antibiotic choice, dosage and clinical outcome which was either discharge
or death. Raw data was coded, entered into Microsoft Excel Version 2013 to create a
database and then exported to STATA Version 13 for analysis. Pearson’s Chi square and
Fischer’s exact test were used to determine associations between predictor variables such
as patient demographics and outcome variables like rational prescribing. Logistic
regression was used to measure the independent correlates of rational antibiotic prescribing
and mortality. Statistical significance was set at 95% confidence interval and values with
p≤0.05 were considered statistically significant.
Results: The mean age of participants was 31.2±15.7 years with a male preponderance
(n=129, 58.6 %). Cephalosporins (49.6%), 5-nitroimidazoles (18.2%) and penicillins
(14.2%) were the most frequently prescribed classes of antibiotics. The prevalence of
irrational use of antibiotics was high at 81.5%, with antibiotic choice, dose, duration and
frequency being incorrect for 51%, 14.4%, 32.3% and 29.2 of the instances, respectively.
Rational use of ceftriaxone was statistically significantly associated with the type of disease
being treated (p=0.012). Mortality at critical care units was 11.1%, with the odds of death
being at least five times among intubated patients compared to those who were not (AOR
5.5, 95% CI=1.1-28.1, p=0.042).
xiv
Conclusion: The prevalence of rational antibiotic use was 18.5%. The high proportion of
irrational use was contributed by incorrect choice and incorrect duration of antibiotic use.
The outcome of antibiotic therapy in critical care units was correlated with extent of the
disease.
Recommendations: The hospital antimicrobial stewardship committee needs to focus on
potential targets for improvement such as the choice and duration of treatment with
antibiotics. Further research is required on determinants of antibiotic prescribing among
clinicians in order to give a better understanding on the factors that guide antibiotic
prescribing. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.rights | Attribution-NonCommercial-NoDerivs 3.0 United States | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/us/ | * |
dc.subject | Use Of Antibiotics Among Patients | en_US |
dc.title | Rational Use Of Antibiotics Among Patients Admitted To Critical Care Units At Kenyatta National Hospital And Its Impact On Clinical Outcomes | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |