Appropriateness of Antibiotic Prescribing and Treatment Outcomes of Hospital-Acquired Infections at Ayder Comprehensive Specialized Hospital, Northern Ethiopia A Hospital-Based Prospective Observational Study

Abstract

Introduction: Appropriate antibiotic prescribing is essential for the effective management of hospital-acquired infections and for reducing antimicrobial resistance. However, inappropriate prescribing remains a major challenge, resulting in poor treatment outcomes. Objective: This study aimed to assess the appropriateness of antibiotic prescribing, treatment outcomes, and associated factors among patients with hospital-acquired infections at Ayder Comprehensive Specialized Hospital. Method: A hospital-based prospective observational study was conducted from January 1 to June 30, 2025, in the internal medicine and pediatric wards. Data were collected through patient chart reviews and interviewer-administered questionnaires. A systematic random sampling technique was used to select 410 patients. The appropriateness of antibiotic prescribing was assessed according to the Infectious Disease Society of America and the Ethiopian National Treatment Guidelines. Data were entered using EpiData version 4.6 and analyzed using SPSS version 27. Bivariate and multivariable binary logistic regression analyses were performed to identify factors significantly associated with inappropriate antibiotic prescribing and poor treatment outcomes (p-value < 0.05). Results: A total of 410 patients with hospital-acquired infections were included in this study, with 180 from internal medicine and 230 from the pediatric ward. Of these patients, 51.2% were female. More than half (61.5%) of the participants received inappropriate antibiotic prescriptions, and 32.4% had poor treatment outcomes. Significant predictors of inappropriate antibiotic prescriptions include the absence of culture testing (AOR = 3.888; 95% CI: 2.252-6.712), presence of comorbidities (AOR = 1.833; 95% CI: 1.102-3.050), prior antibiotic use within three months (AOR = 3.051; 95% CI: 1.387-6.713), and prolonged hospital stay (>21 days) (AOR = 3.277; 95% CI: 1.407-7.631). Similarly, significant predictors of poor treatment outcomes include age over 56 years (AOR = 3.58; 95% CI: 1.19–10.74), multiple comorbidities (AOR = 4.06; 95% CI: 1.18–13.94), bloodstream infections (AOR = 4.11; 95% CI: 2.18–7.72), prolonged hospital stay (>days) (AOR = 2.92; 95% CI: 1.21–7.03), and inappropriate antibiotic prescriptions (AOR = 2.98; 95% CI: 1.62–5.48). Conclusion: Inappropriate antibiotic prescriptions and poor treatment outcomes were common among patients with hospital-acquired infections. To improve treatment outcomes and reduce antimicrobial resistance, it is essential to strengthen culture-guided prescribing, implement antimicrobial stewardship, and optimize management for high-risk patients.