- Title
- Colistin utilisation and clinical outcomes at a public hospital in Bloemfontein, South Africa
- Creator
- Matshediso, Gaalebale Prudence
- Subject
- Gram-negative bacteria
- Subject
- Hospital patients
- Date
- 2022-07
- Type
- Master's theses
- Type
- text
- Identifier
- http://hdl.handle.net/10353/26929
- Identifier
- vital:66172
- Description
- Background Colistin is an antibiotic used as the last resort in the treatment of multi-drug resistant Gram-negative bacteria. Its use started in the 1950s but was decreased in the 1980s owing to its nephrotoxic side effects. The re-emergence of Colistin utilisation in 2012 in South Africa followed the emergence of multi-drug resistant Gram-negative bacteria. There is a dearth of information on the rationale use of Colistin in South Africa. Aim To describe the use of Colistin and its clinical outcomes at a tertiary hospital in Bloemfontein, South Africa. Methodology A retrospective cross-sectional study was conducted at a tertiary hospital in Bloemfontein between 2015 and 2019. Relevant data was extracted from the medical records of patients treated with Colistin. Stratified random sampling was used in selecting 50percent of the eligible medical records of patients treated with Colistin per stratum. Data was analysed using simple descriptive and inferential statistics. Results Of the total sample (N=69), the majority were neonates (43.5percent), while children constituted the lowest number of patients (18.8percent). The highest contributor to the top diagnosis, septicaemia, were neonates (44.2percent). Adherence to policy and Colistin treatment guidelines was suboptimal, more so in neonates (45.3percent) than in adults (73.7percent) and children (72.3percent). Colistin was used as a last resort in 68.1percent of the participants. Cure was achieved in 26.9percent, 46.2percent and 80percent of adults, children and neonates, respectively. The highest rate of nephrotoxicity was seen in adults (57.7percent). In the multivariate logistic regression model analysis, both adults [adjusted odds ratio (AOR)=25.54, 95percent confidence interval (CI) 2.73-238.65] and children (AOR=8.56, 95percentCI 1.06 – 69.10) had a higher risk of death than neonates. However, there was no significant difference in the odds for mortality by gender, co-morbidities, illness duration prior to admission and adherence to treatmen Conclusions This study found a suboptimal level of compliance with policy and recommended guidelines on the use of Colistin in a South African public sector tertiary hospital. In addition, there were variations in the level of compliance by age categories, with lower levels of compliance in neonates than in children and adults. The odds for mortality by gender, co-morbidities, illness duration prior to admission and adherence to treatment guidelines and policies were found to be insignificant, and age was the only predictor of mortality found in the study. The findings of the study highlight the need for improved clinical governance on antibiotic stewardship and monitoring of use of Colistin across all categories of patients in the hospital. Future studies should examine the contributing factors for suboptimal compliance, with evidence-based recommendations on the use of Colistin in the study setting as well as factors contributing to high mortality in adults.
- Description
- Thesis (MPA) -- Faculty of Health Sciences, 2022
- Format
- computer
- Format
- online resource
- Format
- application/pdf
- Format
- 1 online resource (62 leaves)
- Format
- Publisher
- University of Fort Hare
- Publisher
- Faculty of Health Sciences
- Language
- English
- Rights
- University of Fort Hare
- Rights
- All Rights Reserved
- Rights
- Open Access
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UFH Department of Public Health
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | MATSHEDISO GP 201928105 Mini Dissertation.pdf | 2 MB | Adobe Acrobat PDF | View Details Download |