(290) The Effect of antibiotics prescription and length of hospitalization on mortality in patients with systemic infections

Background: Systemic bacterial infections can lead to life-threatening conditions involving the host's response to the infection. Immediate identification and prompt initiation of treatment of disease with antibiotics may reduce patients' mortality rate and reduce hospital stays.

Objectives: To evaluate the effect of antibiotic prescription and length of hospitalization on mortality in patients with bacterial infections.

Methods: This retrospective study was carried out in southwest Nigeria for one year. Consecutive patients with bacterial infections admitted to a tertiary-level hospital were included in the study. Information collected included the age, gender, underlying disease, number and type of antibiotics prescribed, duration of hospital stay and mortality incidence. The influence of antibiotic prescription and length of hospitalization on the mortality rate of patients was estimated using binary logistic regression.

Results: Of the 1280 cases evaluated, 78 patients (Males = 36) had sepsis. The mean (SD) age was 14 ±19. Most infections originated from the gastrointestinal (GI) tract (24.4%). Other sources of sepsis were the urinary tract (N = 7), the lungs (N = 10), skin (N = 1), gluteal (N = 1), meningitis (N = 2), and arthritis (N = 1). The underlying diseases were HIV/AIDS (N = 12), Diabetes mellitus (N = 11), Renal disease (N = 8), Hypertension (N = 5), Tuberculosis (N = 4), immunosuppressive disease (N = 4), Encephalitis (N = 3), cardiovascular disease (N = 2), Anaemia (N = 2), Malaria (N = 2), Peptic ulcer (N = 2). Other diseases present were Arthritis, Cervical cancer, Pneumonia, Chronic obstructive pulmonary disease, Enteric fever, Stroke, Subarachnoid haemorrhage, Upper GI bleeding and Viral hepatitis (N = 1, respectively). Seventy patients had antibiotics prescribed. One patient received six antibiotics. Ten patients received one antibiotic. Most patients received 2-4 antibiotics (75.6%). The antibiotics prescribed were Metronidazole (N = 60), Ceftriaxone (N = 40), Ciprofloxacin (N= 28), Augmentin (N = 22), Trimethoprim/sulfamethoxazole (N = 10), Azithromycin, Clarithromycin, Gentamycin, Flucloxacillin and Ampicillin/Cloxacillin (N = 1 respectively). The mean (SD) length of hospital stay was 10 ±8 days.
The logistic regression model used to assess the effects of the number of antibiotics prescribed and the length of hospital stay on patient mortality was statistically significant, χ2 (3) = 9.398, p < .05. The model explained 22.0% (Nagelkerke R2) of the variance in mortality and correctly classified 66.0% of cases. Increasing the number of antibiotics prescribed led to a reduction in mortality.

Conclusions: Patients benefit from antibiotic prescriptions. Those receiving more than one antibiotic are more likely to have reduced mortality risk.