Tefera Gosaye Mekonen, Sileshi Tesemma, Mekete Mekonnen Derese, Umeta Gurmu Tesfaye
Department of Pharmacy, Ambo University, Ambo, Ethiopia.
Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia.
SAGE Open Med. 2023 Mar 29;11:20503121231161192. doi: 10.1177/20503121231161192. eCollection 2023.
Short intravenous antimicrobial therapy for 2-3 days followed by its per oral comparable antimicrobial course is a crucial part of the antimicrobial stewardship program. However, nothing is known about this practice in Ethiopian hospitals. Therefore, this study assessed the proportion, associations, and outcomes of early intravenous to per oral antimicrobial switch for patients who were admitted to the three wards of Ambo University Referral Hospital.
A hospital-based prospective cohort pilot study was conducted. During the 3-month period, 117 patients met initial inclusion criteria and were followed until Day 3 of intravenous antimicrobial. Of these, 92 (78.6%) subsequently met criteria for early intravenous to per oral switch and are the cohort investigated in this study. Written informed consent was sought from participants and/or parents or guardian for ages 15-17 years. Logistic regression models and independent t-tests were done with a significance of ⩽ 0.05.
Out of 92 study participants, early intravenous to per oral antimicrobial switch was done only for 36 (39.1%). The only independent predictors for lack of early intravenous to per oral antimicrobials switch were poly-pharmacy (adjusted odds ratio = 3.4 at 95% confidence interval, 1.036-11.16; = 0.044). There was a significant difference in terms of mean length of hospital stay (8.80 ± 3.57 versus 3.17 ± 0.74; < 0.0001), in-hospital complication rate (95% versus 5%; < 0.0001), and the mean cost of healthcare in Ethiopian Birrs (652.29 ± 403.29 versus 126.67 ± 29.47; < 0.0001) between the comparator/early intravenous to per oral not switched and early switched group, respectively.
The proportion of early intravenous to per oral antimicrobial switch was unsatisfactory. There was a significant difference between the intervention and comparator groups in terms of length of hospital stay, in-hospital complications, and extra cost. Therefore, implementation of interventions that improve the practice of early intravenous to per oral switch is needed urgently.
短期静脉注射抗菌治疗2 - 3天，随后给予口服等效抗菌疗程，是抗菌药物管理计划的关键部分。然而，埃塞俄比亚医院的这种做法尚无相关研究。因此，本研究评估了安博大学转诊医院三个病房收治患者早期静脉注射改为口服抗菌药物的比例、相关性及结果。
开展一项基于医院的前瞻性队列试点研究。在3个月期间，117名患者符合初始纳入标准，并随访至静脉注射抗菌药物的第3天。其中，92名（78.6%）随后符合早期静脉注射改为口服的标准，为本研究中的队列研究对象。对于15 - 17岁的参与者和/或其父母或监护人，均寻求了书面知情同意。采用逻辑回归模型和独立样本t检验，显著性水平设定为⩽0.05。
在92名研究参与者中，仅36名（39.1%）进行了早期静脉注射改为口服抗菌药物的转换。未进行早期静脉注射改为口服抗菌药物转换的唯一独立预测因素是联合用药（校正比值比 = 3.4，95%置信区间为1.036 - 11.16；P = 0.044）。在住院平均时长（8.80 ± 3.57天对3.17 ± 0.74天；P < 0.0001）、院内并发症发生率（95%对5%；P < 0.0001）以及埃塞俄比亚比尔的医疗保健平均费用（652.29 ± 403.29对比126.67 ± 29.47；P < 0.0001）方面，未转换/早期静脉注射未改为口服组与早期转换组之间存在显著差异。
早期静脉注射改为口服抗菌药物的比例不尽人意。干预组和对照组在住院时长、院内并发症及额外费用方面存在显著差异。因此，迫切需要实施改善早期静脉注射改为口服做法的干预措施。
