Impact of Inappropriate Empirical Antibiotics Therapy on Clinical Outcomes in Adult Patients with Sepsis and Septic Shock at Wad Medani Teaching Hospital, Sudan

Abstract

Background: Inappropriate empirical antimicrobial therapy for sepsis or septic shock patients is independently linked to higher mortality rates. This study aims to evaluate the impact of inappropriate empirical antibiotic therapy on mortality and length of Intensive Care Unit (ICU) stay in adult patients with sepsis and septic shock. Methods: A cross-sectional, retrospective study was conducted in the ICU of Wad Medani Teaching Hospital, Sudan, from January 1st, 2018 to May 31st, 2020. Results: Out of the 101 patients analyzed, 95 (94.06%) received more than one antibiotic (2.772 ± 1), and 78 (77.2%) received inappropriate empirical antibiotics. In total, 17 antimicrobial drugs were used, of which metronidazole was used the most used in 70 patients (69.3%). Aspiration pneumonia was identified as the predominant source of infection in 33 (32.7%) patients. The ICU mortality rate was 77 patients (76.2%), which is significantly associated with inappropriate antibiotics used (P-value: 0.00), with a relative risk of 3.12 (CI 95% 1.66–5.84). Additionally, there was a significant difference in survival depending on the appropriate use of antimicrobials (P-value: 0.00) and Sequential Organ Failure Assessment (SOFA) score (P-value: 0.00). Conclusion: Inappropriate empirical antibiotic use in sepsis or septic shock patients was associated with a higher risk of patient death and more extended hospital stays. This study revealed a significant percentage of inappropriate antibiotic use. These results highlight the significance of creating evidence-based empirical antibiotic protocols for treating sepsis and septic shock and educating healthcare staff on the urgent treatment of these patients and the application of sepsis bundles.