Extent, associated factors and effect of delayed antibiotic initiation in adult inpatients receiving antibiotic treatment at Kisenyi Health Center IV and Kiruddu National Referral Hospital, Kampala, Uganda

Abstract

Delayed appropriate antibiotic initiation increases morbidity and mortality particularly amongst critically ill adult inpatients; therefore, timely antibiotic initiation is highly recommended. Adult inpatients are usually affected by bacterial infections which require in-hospital treatment. Delays in antibiotic treatment are associated with many factors including delayed system referrals, poor patient education, misdiagnosis, delayed diagnosis and resource scarcity, among others. There is limited data on this in our setting necessitating this study. We determined the extent, associated factors, effects of delayed antibiotic initiation in adult inpatients receiving treatment in Kisenyi Health Center IV and Kiruddu National Referral Hospital (KNRH), Kampala Uganda. A prospective cohort study was conducted among adult inpatients at Kisenyi HCIV and Kiruddu NRH, Kampala, Uganda, between 17th April and 20th June 2023, 606 consented adult inpatients participated in the study. A pre-tested interviewer-administered questionnaire was used to collect the data. The data were entered into Epi-data and exported to STATA 17 software for cleaning and analysis. Frequency tables and summary statistics were used to analyses categorical and numerical data. Chi-square tests and logistic regression were used to assess associations between the outcome (delayed antibiotic initiation) and exposure variables (age, level of education, household income, patient residence, marital status, time to consultation, health facility accessibility, number health worker,). Responses to the open-ended questions were coded and analyzed.

Results: The extent of delayed antibiotic initiation was 6 % (36/606), of whom 92% (33/36) were at Kiruddu NRH. Lower household income (adjusted Odds Ratio, aOR= 0.28, p = 0.006 CI =0.12-0.70) and longer patient wait to consultation (aOR= 5.35, p = 0.000 CI =2.10-13.64) were independently associated with delayed antibiotic initiation. Patients who delayed to initiate antibiotics had an average of 81hours (3.38dys) longer in hospital (LOS) than those who received timely antibiotic treatment. The study showed a low extent of delayed antibiotic initiation which was significantly associated with household income and patient wait to consultation. Patients that had delayed antibiotic initiation had longer length of hospital stay. A retrospective mixed methods study at multi-level care should be conducted to explore other effects and associated factors.

Keywords: delayed antibiotic initiation, adult inpatients, extent, length of stay (LOS)