Rational use of antibiotics and covariates of clinical outcomes in patients admitted to intensive care units of a tertiary hospital in Kenya

ABSTRACT Objectives Rational use of antibiotics implies appropriate choice of an antibiotic administered at correct dose, frequency, and duration using the most suitable route of administration. Irrational antibiotics use is associated with antimicrobial resistance, drug failure, and high mortality in the critical care units (CCUs). This study sought to establish rational use of antibiotics and determinants of clinical outcomes of patients admitted to the CCUs at the Kenyatta National Hospital (KNH). The findings would guide policy formulation of antibiotics use in hospital CCUs in Kenya and the region. Methods Retrospective review of 220 admissions to the KNH CCUs over the period February 2018–February 2020 was conducted. Participants’ sociodemographics, clinical characteristics, antibiotics therapy, and outcome of admission were extracted from patient files and analyzed using STATA version 23. Determinants of irrational antibiotic use and covariates of clinical outcomes were computed at 95% confidence. Results The prevalence of rational use of antibiotics was only 18.5%. Inappropriate choice of antibiotics (51.0%) and incorrect duration (32.3%) were the most common irrational practices. Flucloxacillin (100%), cefuroxime (93.3%), cefazolin (85.7%), and ceftriaxone (83.0%) were the most irrationally used antibiotics. Irrational use of ceftriaxone was significantly associated with clinical diagnosis (p = 0.012), while that of amoxiclav was associated with patient risk category (p = 0.039). Mortality in the CCUs was 10%, and the odds of dying were almost six times among intubated patients compared to those who were not (AOR 5.5, 95% CI = 1.1–28.1, p = 0.042). Conclusion Irrational antibiotics prescribing is high in the KNH CCUs, attributable largely to incorrect choice and wrong duration of antibiotic use. Mortality was significantly associated with intubation. Intensification of management in critical care settings should be directed toward intubated patients while ensuring appropriate choice of antibiotics administered for the correct duration. Future studies should explore factors that could promote rational antibiotics use in critical care settings. Plain language summary Background Antibiotics are important in the management of infections. Therefore, they should be used properly as guided by the 5Rs of antimicrobials use, namely, right choice of antibiotic for a particular disease, administered at the right dose, for the right duration, at the right frequency via the right route of administration. Aim We sought to establish the extent to which the use of antibiotics adheres to the established guidelines in the treatment and prevention of infections among patients admitted to intensive care units (ICUs) of Kenyatta National Hospital (KNH), Kenya. Methods We reviewed and analyzed medical records of 220 patients admitted in the KNH ICUs in the period between February 2018 and February 2020. Findings Antibiotics were used properly in only 18.5% of the cases. Unsuitable choice of antibiotics (51.0%) and incorrect duration (32.3%) were the major contributors to improper use. Flucloxacillin (100%), cefuroxime (93.3%), cefazolin (85.7%), and ceftriaxone (83.0%) were the most inappropriately used antibiotics. Approximately 10% of those admitted to the ICU died. Further, the probability of dying was almost six times among intubated patients compared to those who were not. Conclusion The use of antibiotics in the KNH CCUs is not in tandem with established guidelines, owing to inappropriate selection and wrong duration of use. Though death was associated with intubation, more studies are needed to find out factors promoting appropriate antibiotics use in the ICUs so that clinicians can follow them in the treatment of patients.