Inappropriate stress ulcer prophylaxis and associated factors in critically ill patients in Addis Ababa, Ethiopia: a multicenter prospective observational study

Abstract

Abstract Several consensus guidelines provide evidence-based recommendations for appropriate stress ulcer prophylaxis (SUP) use in critically ill patients. However, inappropriate prophylactic use remains common globally. A critical knowledge gap exists regarding SUP prescribing practices in sub-Saharan African ICU settings, particularly Ethiopia, where no multicenter prospective data have been published. Such inappropriate use carries clinical consequences including nosocomial pneumonia, Clostridioides difficile infection, medication costs, and adverse drug events. This study assessed inappropriate SUP use and associated factors in critically ill patients in Addis Ababa, Ethiopia. A multicenter prospective observational study was conducted from September to November 2021 in three public hospital ICUs in Addis Ababa. All critically ill patients admitted during the study period who stayed ≥ 24 h and received at least one medication were included. Appropriateness was assessed using ASHP guideline criteria, with explicit operational definitions for overuse, underuse, and inappropriate continuation at discharge. Multivariable logistic regression analysis was used to assess the independent predictors for the inappropriate stress ulcer prophylaxis utilization in the study hospitals. The association was declared to be statistically significant at a 95% confidence interval and p-value < 0.05. Of 229 patients, one-third (32.8%) were pediatric. Inappropriate SUP use occurred in 89 (38.9%) at/before admission, 130 (56.8%) during ICU stay, and 51 (34.2%) at discharge. Notably, 24.8% of patients were discharged on unnecessary SUP, representing a key stewardship gap. Overuse (SUP without indication) accounted for 14.8% of inappropriate use during ICU stay, while underuse (indication without SUP) occurred in 16.6%. On multivariable analysis, acute pancreatitis was the only independent predictor of inappropriate SUP use at discharge (AOR = 0.048, 95% CI 0.003–0.807, p = 0.035). Age ≥ 65 years was associated with appropriate SUP use at admission (AOR = 3.609, 95% CI 1.171–11.212) and during ICU stay (AOR = 3.132, 95% CI 1.07–9.165). in conclusion, inappropriate SUP use is common across all phases of ICU care in Ethiopian public hospitals. Acute pancreatitis emerged as a predictor requiring cautious interpretation given the small sample size. These findings underscore an urgent need for targeted educational and stewardship interventions to optimize SUP prescribing, reduce unnecessary medication exposure, and improve patient safety in Ethiopian ICUs.