Risk Factors for Inappropriate Antimicrobial Therapy Among Patients with Hospital-Acquired Infection at Jimma Medical Center: A Prospective Observational Study

BACKGROUND: Globally, HAIs affect about 2 million people annually and result in 5% to 15% hospitalizations. In low-middle-income countries, antibiotics are improperly prescribed for 44% to 97% of hospitalized patients. A report in Ethiopia revealed that about 66.7% of HAIs are managed inappropriately. OBJECTIVE: To identify inappropriate antimicrobial therapy (AMT) and its risk factors among patients with HAIs at Jimma Medical Center (JMC). METHODS: A prospective observational study was conducted involving 300 patients with HAIs in medical, surgical, and gynecology-obstetrics wards of JMC, from October 2020 to April 2021. Data were collected using data abstraction format. Logistic regression was conducted to assess factors associated with AMT inappropriateness. A p-value <0.05 was considered to declare statistical significance. RESULTS: The overall mean age (± standard deviation) of the participants was 43.2 ± 19.2 years and 183 (61.0%) of them were females. About three-fourths (76.0%) of patients with HAIs were treated inappropriately. Hospital-acquired pneumonia (50.3%) was the most common type of HAI identified in this study. The frequent class of inappropriate AMT was an inappropriate choice, 102 (44.1%), followed by an inappropriate dose, 88 (38.1%), and inappropriate indication, 59 (24.2%). On multivariable logistic regression, patients having culture finding (AOR = 0.32, p = 0.016), taking metronidazole (AOR = 0.25, p = 0.001), and taking vancomycin (AOR = 2.93, p = 0.001) were significantly associated with inappropriate AMT. CONCLUSION: Inappropriate AMT was identified in about three-fourths of the patients with HAIs. A decrease in the likelihood of inappropriate AMT was identified in patients having culture findings and in those taking metronidazole, whereas taking vancomycin increased the likelihood of inappropriate AMT. Therefore, the authors recommend scaling up the capacity of definitive therapy through culture and sensitivity tests. Furthermore, training of prescribers in the rational use of antimicrobials is also warranted.