DOI: 10.14457/tu.the.2024.68
title: An assessment of antibiotic treatment guideline adherence for common infections in a tertiary care hospital with established antimicrobial stewardship program in Kathmandu, Nepal

description: Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The study aimed to assess the physician’s adherence to hospital antibiotic treatment guidelines recommendations and determine the prescription pattern linked to non-adherent antibacterial medication, and the frequency of de-escalation of empiric treatment regimens deemed necessary by microbiological reports. The study was a retrospective monocentric observational review of medical records of adult inpatients diagnosed with urinary tract infection (UTI), pneumonia, and skin and soft tissue infection (SSTI) from January 2018 to December 2019. Adherence was defined as the physician’s antibiotic prescribing practices that implied the correctness of the empiric antibiotic selection, dosage, and duration of therapy. Of 2077 reviewed medical records that were originally derived from 954 UTI, 754 pneumonia, and 369 SSTI inpatients, 354 (17%) inpatients included 87 UTI, 180 pneumonia, and 87 SSTI; of these patients eligible for analysis, inpatients with antibiotic prescriptions: 33 (37.9%) UTI; 78 (43.3%) pneumonia; and 23 (26.4%) SSTI were adherent to guideline recommendations. The inpatients receiving Ceftriaxone (OR = 2.09, 95% CI = 1.18-3.71, p = 0.012) and Levofloxacin (OR = 4.63, 95% CI = 1.30-16.53, p = 0.018) had more significantly increased adherence to treatment guidelines. The hospital department, patient age group, presence of comorbidities, and type of infectious disease diagnosis were not significantly associated with adherence to antibiotic prescribing practice guidelines.Among the 220 non-adherent inpatients including 54 (62.1%) UTI, 102 (56.7%) pneumonia, and 64 (73.6%) SSTI, patients treated for SSTI were more likely (COR= 4.47, 95% CI= 1.46-13.63, p = 0.009) to have an incorrect selection of antibiotics by the prescribing physicians than UTI patients. The patients treated for SSTI were more likely (COR= 4.21, 95% CI= 1.39-12.78, p = 0.011) to have an incorrect dose of antibiotics by the prescribing physicians than those UTI patients. Similarly, the ICU ward had less likely (COR = 0.47, 95% CI = 0.23-0.98, p = 0.044) to have an incorrect duration of antibiotics by the prescribing physicians than the general medical ward.Antimicrobial susceptibility testing results indicated the appropriateness of de-escalation in as many as 67%(n=237) of the patients included in the analysis. However, over half of the patients did not experience de-escalation. The regimens were either too broad (67%) or too narrow (10%). The highest proportion of non-de-escalation was observed in patients admitted for SSTI (81%). Averagely 20% of all patients included in the analysis, the switch of antibiotic was performed in 72 hours.This study revealed low adherence despite the availability of the updated guideline for an antibiotic prescription. The findings confer an urgent need to confront the antibiotic prescription pattern in such tertiary care centers for tailored interventions to improve adherence to guidelines, particularly focusing on prescriptions of antibiotic types. It is also imperative to reduce broad-spectrum antibiotic exposure to patients with acute infections based on microbiological culture reports and minimize the development of resistant microbes.