Gashaw Mulatu, Berhane Melkamu, Bekele Sisay, Melaku Tsegaye, Lemmi Gemechu, Chelkeba Legese, Wakjira Tekle, Tesfaw Getnet, Mekonnen Zeleke, Kroidl Arne, Wieser Andreas, Froeschl Guenter, Seeholzer Thomas, Ali Solomon, Gudina Esayas Kebede
School of Medical Laboratory Science, Jimma University, Jimma P.O. Box 378, Ethiopia.
CIHLMU Center for International Health, University Hospital, LMU Munich, Leopoldstrasse 5, 80802 Munich, Germany.
J Clin Med. 2025 Apr 1;14(7):2413. doi: 10.3390/jcm14072413.
The discovery of antibiotics revolutionized healthcare by significantly reducing morbidity and mortality. However, excessive and inappropriate use has led to a global surge in antimicrobial resistance, particularly in low- and middle-income countries. This study aimed to evaluate antibiotic use patterns among inpatients at Jimma Medical Center (JMC) in Southwest Ethiopia. A longitudinal observational study was conducted in February and March 2019 at JMC, focusing on patients admitted for over 24 h who received antibiotics. Data on patient demographics, clinical indications, and antibiotics prescribed were systematically collected. Antibiotic consumption rates were measured as days of therapy (DOTs) per 100 patient-days, and utilization was classified according to the World Health Organization (WHO) AWaRe (Access, Watch, and Reserve) framework. A total of 384 inpatients were included, with a male predominance (53.9%) and a median age of 24 years (IQR: 5-37). In total, 634 antibiotic regimens were prescribed. According to the WHO AWaRe classification, 48.3% (306/634) were "Access" and 51.7% (328/634) were "Watch" antibiotics. Patients were treated with antibiotics for a median duration of 4 days (IQR: 2-7), leading to a total of 2880 days of antibiotic therapy. Ceftriaxone was the most commonly prescribed antibiotic, with a usage rate of 44.65 DOTs per 100 patient-days. Substantial variability was observed in empirical antibiotic regimens among treating physicians and across wards. Culture and antibiotic susceptibility testing (AST) were performed for only 4.2% of patients, and none of the treatments were modified based on susceptibility data. The study highlights critical issues in antibiotic prescribing at JMC, including over-reliance on "Watch" antibiotics, predominantly ceftriaxone, limited use of AST results, and deviations from standard treatment guidelines. Addressing these challenges requires implementing antimicrobial stewardship programs, developing evidence-based local treatment guidelines, and strengthening and encouraging the use of microbiology services to improve rational antibiotic use.
抗生素的发现通过显著降低发病率和死亡率彻底改变了医疗保健。然而，过度和不当使用导致全球抗菌药物耐药性激增，特别是在低收入和中等收入国家。本研究旨在评估埃塞俄比亚西南部吉马医疗中心（JMC）住院患者的抗生素使用模式。2019年2月和3月在JMC进行了一项纵向观察性研究，重点关注住院超过24小时且接受抗生素治疗的患者。系统收集了患者人口统计学、临床指征和所开抗生素的数据。抗生素消耗率以每100患者日的治疗天数（DOTs）来衡量，并根据世界卫生组织（WHO）的AWaRe（可及、慎用和储备）框架进行分类。共纳入384名住院患者，男性占多数（53.9%），中位年龄为24岁（四分位间距：5 - 37岁）。总共开出了634种抗生素治疗方案。根据WHO的AWaRe分类，48.3%（306/634）为“可及”类抗生素，51.7%（328/634）为“慎用”类抗生素。患者接受抗生素治疗的中位时长为4天（四分位间距：2 - 7天），导致抗生素治疗总天数达2880天。头孢曲松是最常开具的抗生素，使用率为每100患者日44.65个DOTs。在治疗医生之间以及各病房的经验性抗生素治疗方案中观察到了很大差异。仅对4.2%的患者进行了培养和抗生素敏感性测试（AST），且没有任何治疗方案根据敏感性数据进行调整。该研究突出了JMC在抗生素处方方面的关键问题，包括过度依赖“慎用”类抗生素（主要是头孢曲松）、AST结果使用有限以及偏离标准治疗指南。应对这些挑战需要实施抗菌药物管理计划、制定基于证据的当地治疗指南，以及加强并鼓励使用微生物学服务以改善抗生素的合理使用。
