Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?

Abstract

Purpose Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. Methods We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016—June 2019. Demographics, antimicrobial use, culture data, and outcome were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival. Results Among 92 gastroschisis patients, mortality was 77%(n = 71); 23%(n = 21) died within 48 hours. 98%(n = 90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n = 38). Patients spent 86%(SD = 20%) of hospital stay on antibiotics and 38%(n = 35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p < 0.001) compared to survivors. There was no difference in the proportion of hospital stay on second-line antibiotics (p = 0.1). Conclusion Frequent late deaths due to sepsis, prolonged antibiotic courses, and regular use of second-line antibiotic agents were identified in this retrospective cohort of gastroschisis patients. Future studies are needed to evaluate antimicrobial resistance in Rwanda.