Assessment of discrepancy between empirical antibiotics and cultures results in febrile patients at CHUK

Abstract

Background: Inappropriate use of antibiotic therapy is a global public health concern. This significantly contributes to an increase in antimicrobial resistance, disproportionately higher in low and middle-income countries. In Rwanda, there is a lack of information about the accurate use of empirical antibiotic therapy. It is in this regard we did this study to compare the empirical prescription of antibiotic therapy to the antibiogram results at the university teaching hospital of Kigali (CHUK), Rwanda.

Methods: This is a cross-sectional study among population aged 15 years and above with febrile illnesses and exposed to empirical antibiotics who have either positive cultures, positive genexperts, or positive cryptococcal antigen at the tertiary teaching hospital CHUK. The study evaluated the accurate use of empirical antibiotic therapy and the short-term outcome in hospitalized patients from August 2021 to April 2022. Demographic data, clinical presentation, and laboratory test results were recorded using a questionnaire after a signed consent. Stata version 13 was used to conduct descriptive, univariate, and multivariate analyses to determine the distribution of antibiotic prescriptions and factors associated with mortality.

Results: Over 9 months, we enrolled 150 participants in the study. The mean age was 48 ranging from 15 to 98 years of age, and there was a nearly equal distribution of gender with 52.7% of females and 47.3% of males. 64% of the study population had discordance between empirical antibiotic use and the antibiogram results. Of all cultures and genexperts done, E.coli was the most commonly isolated germ at 28.7% followed by Klebsiella pneumonia, Mycobacterium tuberculosis, and Staphylococcus aureus at 23.3%, 17.3%, and 6.7% respectively. Inappropriate use of empirical antibiotic therapy was associated with high inhospital mortality (OR=7.73, 95% CI: 1.74-34.31, p=0.007).

Conclusion: There is an inappropriate use of antibiotic therapy in tertiary hospital settings and this may be associated with high in-hospital mortality. The majority of admitted patients received third-generation cephalosporins, which have a high resistance rate, and the most common germs isolated in hospital cultures and genexperts were E.coli, Klebsiella spp., and Mycobacterium tuberculosis. Behavior changes in antibiotics prescription and the development of local guidelines for antibiotics prescription is warranted to address this burden.