Acta tropica · 2025
When microbiology is missing: A prospective observational study on empirical first-line antibiotic treatment (FLAT) in Ethiopia.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cotugno Sergio, Guido Giacomo, Acquasanta Angela, Dilba Tujube, Tulone Ottavia, Fikru Abishe, Teresa Mokonen, Segala Francesco Vladimiro, Gulo Behranu, Putoto Giovanni, Tafesse Yoseph, Barbieri Viviana, Reta Abdi, Manenti Fabio, Bobbio Flavio Antonio, Schuldt Gerlind, Kenate Sori Birhanu, Benoni Roberto, Saracino Annalisa, Di Gennaro Francesco
Аннотация
BACKGROUND: Antimicrobial resistance (AMR) is a growing public health threat, particularly in low- and middle-income countries (LMICs) where diagnostic capacity is limited. In such settings, empirical first-line antibiotic treatment (FLAT) is often the only feasible therapeutic approach, but real-world evidence on its effectiveness in adult populations is scarce.
METHODS: We conducted a prospective observational cohort study at St. Luke Hospital, Wolisso, Ethiopia, from May 2024 to February 2025. Patients aged ≥5 years, admitted to the medical or surgical wards and prescribed antibiotics upon admission, were enrolled. Those on antimicrobial therapy prior to admission or receiving anti-tubercular treatment alone were excluded. Sociodemographic, clinical, and treatment data were collected. FLAT failure-defined as lack of clinical improvement within 48-72 h without non-infectious explanations-was the primary outcome. Associations with FLAT failure were assessed using univariate and multivariable logistic regression.
RESULTS: A total of 118 patients (49.2 % female; median age 42.0 years) were included; 81.4 % were admitted to the medical ward. Pneumonia was the most common diagnosis (55.9 %). Ceftriaxone, alone or in combination, was the predominant empirical regimen (96.6 %). FLAT failure occurred in 11 patients (10.2 %; 95 % CI 4.7-16.1 %), resulting in additional antibiotic exposure, prolonged hospitalisation, referral to tertiary facilities (27.3 %), and one death (9.1 %). In multivariable analysis, admission to the surgical ward was associated with higher odds of FLAT failure (OR 5.6, 95 % CI 1.1-35.1; p = 0.045). No other consistent patient-level predictors were identified.
CONCLUSIONS: In a low-resource hospital setting without microbiological support, empirical FLAT achieved a relatively low failure rate. However, failures were clinically significant, leading to escalation of therapy and adverse outcomes. Strengthening antimicrobial stewardship through context-specific empirical treatment protocols, alongside efforts to improve diagnostic capacity, is essential to optimise patient care and mitigate AMR in similar settings.
METHODS: We conducted a prospective observational cohort study at St. Luke Hospital, Wolisso, Ethiopia, from May 2024 to February 2025. Patients aged ≥5 years, admitted to the medical or surgical wards and prescribed antibiotics upon admission, were enrolled. Those on antimicrobial therapy prior to admission or receiving anti-tubercular treatment alone were excluded. Sociodemographic, clinical, and treatment data were collected. FLAT failure-defined as lack of clinical improvement within 48-72 h without non-infectious explanations-was the primary outcome. Associations with FLAT failure were assessed using univariate and multivariable logistic regression.
RESULTS: A total of 118 patients (49.2 % female; median age 42.0 years) were included; 81.4 % were admitted to the medical ward. Pneumonia was the most common diagnosis (55.9 %). Ceftriaxone, alone or in combination, was the predominant empirical regimen (96.6 %). FLAT failure occurred in 11 patients (10.2 %; 95 % CI 4.7-16.1 %), resulting in additional antibiotic exposure, prolonged hospitalisation, referral to tertiary facilities (27.3 %), and one death (9.1 %). In multivariable analysis, admission to the surgical ward was associated with higher odds of FLAT failure (OR 5.6, 95 % CI 1.1-35.1; p = 0.045). No other consistent patient-level predictors were identified.
CONCLUSIONS: In a low-resource hospital setting without microbiological support, empirical FLAT achieved a relatively low failure rate. However, failures were clinically significant, leading to escalation of therapy and adverse outcomes. Strengthening antimicrobial stewardship through context-specific empirical treatment protocols, alongside efforts to improve diagnostic capacity, is essential to optimise patient care and mitigate AMR in similar settings.