# Empirical antibiotic use, resistance patterns, and their impact on clinical outcomes in a Yemeni tertiary hospital

## TL;DR

The study found high misuse of antibiotics in a Yemeni hospital, leading to resistance and poor patient outcomes, highlighting the need for better diagnostic tools and stewardship.

## Contribution

The study provides new insights into antibiotic misuse and resistance patterns in a Yemeni hospital and their impact on clinical outcomes.

## Key findings

- 98% of patients received empirical antibiotics, with 68.3% of cultures being negative.
- Correct empirical therapy improved prognosis (p=.029), while Ceftriaxone was linked to poorer outcomes (p=.017).
- Resistance exceeded 50% for Ceftriaxone and Cefepime, with Cefuroxime showing the lowest resistance at 42%.

## Abstract

Antibiotic (AB) resistance is a global health threat, particularly in resource-limited settings like Yemen. Antibiotics misuse, especially in hospitals, is the most important risk for resistance development. Understanding empirical AB use and susceptibility patterns among inpatient settings is crucial for implementing effective antimicrobial stewardship.

To evaluate Empirical Antibiotic Therapy (EAT), resistance patterns, and their impact on hospitalized patients’ outcomes.

A prospective cross-sectional study was conducted in medical and surgical wards in a tertiary hospital over 2 months, including 80 adult patients for analysis. The patient-level data on antibiotic prescriptions, culture results, patient demographics, clinical characteristics, and treatment outcomes, were collected manually and from computer records. An ethical approval was obtained, and SPSS app was used in analyzing the data.

EAT was alarmingly high (98%), often mismatched susceptibility patterns, coupled with high percentage (68.3%) of negative culture results. The most commonly prescribed antibiotics were Ceftriaxone, Vancomycin, Levofloxacin, Meropenem, Imipenem/Cilastatin, and Metronidazole. Significant resistance (>50%) was observed against Moxifloxacin, Clindamycin, and all tested beta-lactam agents except Cefuroxime (42%). Appropriate EAT was associated with good prognosis, P = .029 (Fisher's Exact Test), and Ceftriaxone use was associated with poorer prognosis, P = .017 (X2 Test).

The study highlights a notable misuse of EAT coupled with high resistance rate in hospital. These findings underscore the need for effective interventions to optimize antibiotic use and mitigate the growing threat of resistance in Yemen. Strategies such as enhanced diagnostic capabilities, improved stewardship programs, and rational prescribing practices are essential to improve patient outcomes and preserve the effectiveness of antibiotics.

•98% of patients received empirical antibiotics, though 68.3% of cultures were negative and many were mismatched.•Resistance exceeded 50% for Ceftriaxone and Cefepime; Cefuroxime showed the lowest resistance at 42%.•Correct empirical therapy improved prognosis (p=.029), while Ceftriaxone was linked to poorer outcomes (p=.017).•Delayed culture results, often arriving after discharge, led to a heavy reliance on EAT and worse patient outcomes.•Findings highlight an urgent need for better diagnostics and stewardship to tackle antibiotic resistance in Yemen.

98% of patients received empirical antibiotics, though 68.3% of cultures were negative and many were mismatched.

Resistance exceeded 50% for Ceftriaxone and Cefepime; Cefuroxime showed the lowest resistance at 42%.

Correct empirical therapy improved prognosis (p=.029), while Ceftriaxone was linked to poorer outcomes (p=.017).

Delayed culture results, often arriving after discharge, led to a heavy reliance on EAT and worse patient outcomes.

Findings highlight an urgent need for better diagnostics and stewardship to tackle antibiotic resistance in Yemen.