Determinants of Treatment Outcomes and Antibiotic Appropriateness Among Hospitalized Patients of Skin and Soft Tissue Infections at University of Gondar Comprehensive and Specialized Hospital, Gondar, Northwest Ethiopia: 2023/2024; A Prospective, Observational Study

Abstract

ackground: Skin and soft tissue infections pose a tremendous risk for hospitalized patients, mainly due to their resulting worse clinical outcomes. However, there have been limited studies regarding antibiotic therapy and treatment outcomes in such types of infectious diseases. Objective: This study aimed to explores the determinants of treatment outcomes and antibiotic appropriateness in hospitalized patients of skin and soft tissue infections. Methods: We performed a prospective observational study in inpatient wards spanning 6 months between March 25, through September 30, 2023 at UGCSH, Gondar, Ethiopia. Data was collected based on structured data abstraction via systematic sampling techniques to make up 423. Data was analyzed using IBM SPSS version 25.0. Descriptive statistics was used to characterize continuous and categorical variables as appropriate. T-test, ANOVA, and chi-square test were used to assess mean differences of variables. Two-way Kappa analysis was used to measure the extent of agreement between raters for antibiotic appropriateness. Multivariate logistic and multiple linear regression were used to analyze treatment outcome predictors. All statistical tests were two-tailed and p<0.05 denotes statistical significance. Results: Overall, antibiotic prescribing patterns in terms of WHO “access”, “watch “and “reserve” antibiotic utilization was found to be 46.6%,30.7%, and 22.7% respectively, and antibiotic regimen of 61.2%,22.5%, and 16.3% rating “appropriate”, over and under appropriate respectively. The mean hospital length of stay was 13.46 ±3.01days. Patients achieving clinical response within 48-72hr were 39.3%, while 34.1% encountered treatment failure, with the overall in-hospital mortality of 0.7%. Comorbidities, antibiotic appropriateness, living status, achieving early clinical response, residency, and de-escalation strategy were strongly associated with hospital length of stay and treatment failure. Conclusion: Relatively higher consumption of reserve and watch antibiotics was observed for prolonged hospital antibiotic courses, emphasizing the necessity of clinicians’ prompt evaluation of patient clinical history for curbing imprudent antibiotic utilization and improving clinical outcomes, and this again sheds light on the current and future clinical management of SSTIs. An effective antibiotic stewardship program and relevant healthcare professionals’ attention are needed to sustain and efficiently use available antibiotics and improve patient clinical outc