ArticleJAC-antimicrobial resistance2020
Prolonged empirical antibiotic therapy is correlated with bloodstream infections and increased mortality in a tertiary care hospital in Ethiopia: bacteriology testing matters.
Article in JAC-antimicrobial resistance, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Progress on implementing the WHO-GLASS recommendations on priority pathogen-antibiotic sensitivity testing in Africa: AWellcome open research · 2024Pooled it
- Etiological spectrum of persistent fever in the tropics and predictors of ubiquitous infections: a prospective four-country study with pooled analysis.BMC medicine · 2022Trial
- A multicenter point-prevalence survey of antibiotic utilization patterns in Ethiopia: implications for strengthening stewardship programs.BMC infectious diseases · 2026Article
- Prevalence of multidrug resistant gram-negative bacteria and associated factors among gram-negative blood culture isolates at Tikur Anbessa Specialized Hospital: a retrospective study.BMC infectious diseases · 2025Article
- Major blood stream infection-causing bacterial pathogens, antimicrobial resistance patterns and trends: a multisite retrospective study in Asmara, Eritrea (2014-2022).Annals of clinical microbiology and antimicrobials · 2025Article
- Bloodstream Infection and Associated Factors at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: A Prospective Cross-Sectional Study.BioMed research international · 2025Article
- Canadian Antibiotic Prescribing for Sepsis (CAPS) Study: AJournal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2024Article
- Evaluation of three protocols for direct susceptibility testing for gram negative-Enterobacteriaceae from patient samples in Uganda with SMS reporting.Scientific reports · 2024Article
- Impact of Antibiotic Time-Outs in Multidisciplinary ICU Rounds for Antimicrobial Stewardship Program on Patient Survival: A Controlled Before-and-After Study.Critical care explorations · 2023Article
- Cefazolin access and use in Ethiopia: A policy implication.PLOS global public health · 2023Article
- The neglected importance of high-endemic ESBL sites.JAC-antimicrobial resistance · 2022Article
- Accuracy of C-reactive Protein and Procalcitonin for Diagnosing Bacterial Infections Among Subjects With Persistent Fever in the Tropics.Open forum infectious diseases · 2022Article
- Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis.Implementation science : IS · 2022Article
- Cost-utility analysis of antimicrobial stewardship programme at a tertiary teaching hospital in Ethiopia.BMJ open · 2021Article
- Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021Review
- Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece.Global implementation research and applications · 2021Article
- A Feasible Laboratory-Strengthening Intervention Yielding a Sustainable Clinical Bacteriology Sector to Support Antimicrobial Stewardship in a Large Referral Hospital in Ethiopia.Frontiers in public health · 2020Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHospital-associated infection (HAI) and antimicrobial resistance (AMR) are major health threats in low- and middle-income countries (LMICs). Because diagnostic capacity is lacking throughout most of Africa, patients are commonly managed with prolonged empirical antibiotic therapy. Our goal was to assess mortality in relation to HAI and empirical therapy in Ethiopia's largest referral hospital.
methodsCohort study of patients with suspected HAI at Tikur Anbessa Specialized Hospital from October 2016 to October 2018. Blood culture testing was performed on an automated platform. Primary outcomes were proportion of patients with bloodstream infection (BSI), antibiotic resistance patterns and 14 day mortality. We also assessed days of therapy (DOT) pre- and post-blood culture testing.
resultsOf 978 enrolled patients, 777 had blood culture testing; 237 (30%) had a BSI. Enterobacteriaceae were isolated in 49%; 81% of these were cephalosporin resistant and 23% were also carbapenem resistant. Mortality at 14 days was 31% and 21% in those with and without BSI, respectively. Ceftriaxone resistance was strongly correlated with mortality. Patients with BSI had longer DOT pre-blood culture testing compared with those without BSI (median DOT 12 versus 3 days, respectively,
conclusionsBSI are frequent and fatal among patients with suspected HAI in Ethiopia. Highly resistant blood isolates are alarmingly common. This study provides evidence that investing in systematic blood culture testing in LMICs identifies patients at highest risk of death and that empirical management is frequently inappropriate. Major investments in laboratory development are critical to achieve better outcomes.
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