Antimicrobial Prescribing Patterns in Critical Care and Compliance to Guideline at the Kenyatta National Hospital.

Abstract

Background: Antimicrobial resistance (AMR) is a serious and growing threat to global health today. Critically ill patients have a high risk of developing life-threatening infections. Hence, antimicrobial agents are the most commonly prescribed medicines for these patients. The extensive and indiscriminate use of antimicrobial agents in the Critical Care Unit (CCU) is a major contributor to the development of resistant pathogens. Study Objective: To determine the patterns of antimicrobial prescribing among the patients admitted to the CCU and the level of compliance to the Kenyatta National Hospital Guide to Antimicrobial Therapy in the Critical Care Unit. Methods: A retrospective longitudinal study was conducted at the selected CCUs of Kenyatta National Hospital (KNH). The study involved the extraction of data from medical records of patients aged 13 years and above admitted to the CCUs from January to December 2017. Data were abstracted from patient medical records, treatment sheets and laboratory culture and sensitivity reports using a pre-designed standardized data collection tool. The two primary outcomes of interest were the degree of compliance to KNH-CCU guidelines in terms of the choice of antimicrobial agent prescribed and the level of antimicrobial switch informed by culture and susceptibility results. All data were subjected to descriptive statistical analysis and reported as proportions and percentages (%). The association between predictor variables and outcome variables was determined using the Chi-square test. Logistic regression was undertaken to measure the relationship between the outcome variable compliance to the KNH guideline and several predictor variables such as patients’ age, sex, and diagnosis. The level of significance was set at 0.05................