Extended antimicrobial use and its associated factors among patients admitted to surgical wards of public hospitals, Harar, Eastern Ethiopia: a cross-sectional study

Abstract Antimicrobial agents are more likely to be misused than other drugs in hospitals. However, there are limited studies addressing the extended antibiotic use in surgical wards in Ethiopia, particularly in the study area. Therefore, the aim of this study was to assess the magnitude of extended antimicrobial use and its associated factors at public hospitals in Harar, Eastern Ethiopia from June 10 to October 10, 2021. A cross-sectional study was conducted at Haramaya University Hiwot Fana Comprehensive Specialized Hospital (HUHFCSH) and Jugal General Hospital (JGH). A total of 423 patients were selected using systematic random sampling. Data were collected using a structured quantitative abstraction tool and analyzed using SPSS version 22. Bivariable and multivariable binary logistic regression analyses were conducted. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to assess associations, and P < 0.05 was considered statistically significant. The overall prevalence of extended antimicrobial use was 73.0% (95% CI 69–77%). Extended prophylaxis was observed in 293 (69.3%) participants, including 258 (60.9% of the total cohort) post-operative, 33 (7.8%) pre-operative, and 2 (0.5%) medical prophylaxis cases. Extended treatment duration was observed in 16 (3.8%) participants. Male sex (AOR: 2.88, 95% CI 1.44–5.76), prophylactic antibiotic use (AOR: 20.62, 95% CI 8.19–51.95), and 1–10 days of hospital stay (AOR: 0.27, 95% CI 0.15–0.48) were significantly associated with extended antimicrobial use. Extended antimicrobial use was high, driven primarily by prolonged post-operative prophylaxis. Targeted stewardship interventions addressing surgical prophylaxis duration, disease prevalent to the male sex, duration of hospital stay, and availability of appropriate first-line prophylactic agents are needed.