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Marque P, Leitao J, Dauchy FA, Gerbouin O, Fabre T, Xuereb F, Lahouati M. Assessment of the impact of telehealth intervention in patients with bone and joint infection. Infect Dis Now 2024; 54:104906. [PMID: 38580052 DOI: 10.1016/j.idnow.2024.104906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES Patients with bone and joint infections (BJI) are involved in a complex care pathway and require prolonged antimicrobial treatment. Some studies have suggested that a pharmacist-led telehealth intervention (TI) could help to ensure better follow-up of chronic diseases. To our knowledge, there are no data on the effects of pharmacist-led TI on patients with BJI. The aim of this study is to assess the impact of a TI on patients treated for BJIs at three weeks after hospital discharge. PATIENTS AND METHODS Patients encountered during hospitalization and receiving standardized care including TI were included in the study. All adverse events (AE) reported by patients during TI were evaluated. Impact of pharmaceutical interventions (PIs) provided by a clinical pharmacist following TI was evaluated by CLEO© (CLinical, Economic and Organizational) scale. Patient satisfaction concerning TI was assessed by an anonymous questionnaire following medical consultation at the end of antimicrobial treatment. RESULTS Over a 4-month period, 36 patients received TI. Fifty-two AEs were identified in 21 patients (58%). Two patients were hospitalized due to an AE. Clinical pharmacists provided 34 pharmaceutical interventions (PIs) for 23 patients (64%). According to CLEO scale, 11 PIs had a major clinical impact (32%), 6 PIs (18%) had a favorable impact on the direct cost of treatment and 27 PIs (79%) had positive organizational impact. Concerning TI process, patients were satisfied or very satisfied, with an average score of 9.6/10. CONCLUSION TI led to a high number of pharmaceutical interventions (PIs), with a meaningful clinical, organizational, and economic impact. Patients were also highly satisfied with this intervention.
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Affiliation(s)
- Philippine Marque
- CHU de Bordeaux, Hôpital Pellegrin, Service de pharmacie clinique, Bordeaux, France
| | - Julie Leitao
- CHU de Bordeaux, Hôpital Pellegrin, Service de maladies infectieuses, Bordeaux, France
| | | | - Olivier Gerbouin
- CHU de Bordeaux, Hôpital Pellegrin, Service de pharmacie clinique, Bordeaux, France
| | - Thierry Fabre
- CHU de Bordeaux, Hôpital Pellegrin, Service de chirurgie orthopédique, Bordeaux, France
| | - Fabien Xuereb
- CHU de Bordeaux, Hôpital Pellegrin, Service de pharmacie clinique, Bordeaux, France; Université de Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France
| | - Marin Lahouati
- CHU de Bordeaux, Hôpital Pellegrin, Service de pharmacie clinique, Bordeaux, France; Université de Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France.
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Baclet N, Forestier E, Gavazzi G, Roubaud-Baudron C, Hiernard V, Hequette-Ruz R, Alfandari S, Aumaître H, Botelho-Nevers E, Caraux-Paz P, Charmillon A, Diamantis S, Fraisse T, Gazeau P, Hentzien M, Lanoix JP, Paccalin M, Putot A, Ruch Y, Senneville E, Beuscart JB. One Hundred Explicit Definitions of Potentially Inappropriate Prescriptions of Antibiotics in Hospitalized Older Patients: The Results of an Expert Consensus Study. Antibiotics (Basel) 2024; 13:283. [PMID: 38534718 DOI: 10.3390/antibiotics13030283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND In geriatrics, explicit criteria for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. OBJECTIVE To produce an expert consensus on explicit definitions of antibiotic-PIPs for hospitalized older patients. METHODS We conducted a Delphi survey involving French experts on antibiotic stewardship in hospital settings. During the survey's rounds, the experts gave their opinion on each explicit definition, and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were adopted. The results were discussed during consensus meetings after each round. RESULTS Of the 155 invited experts, 128 (82.6%) participated in the whole survey: 59 (46%) infectious diseases specialists, 45 (35%) geriatricians, and 24 (19%) other specialists. In Round 1, 65 explicit definitions were adopted and 21 new definitions were suggested. In Round 2, 35 other explicit definitions were adopted. The results were validated during consensus meetings (with 44 participants after Round 1, and 54 after Round 2). CONCLUSIONS The present study is the first to have provided a list of explicit definitions of potentially inappropriate antibiotic prescriptions for hospitalized older patients. It might help to disseminate key messages to prescribers and reduce inappropriate prescriptions of antibiotics.
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Affiliation(s)
- Nicolas Baclet
- CHU Lille, University of Lille, F-59000 Lille, France
- Groupe Hospitalier de l'Institut Catholique (GHICL), Service de Maladies Infectieuses, Université Catholique de Lille, F-59160 Lille, France
| | - Emmanuel Forestier
- Service de Maladies Infectieuses, Centre Hospitalier Métropole Savoie, F-73000 Chambéry, France
| | - Gaëtan Gavazzi
- Clinique Universitaire de Médecine Gériatrique, Centre Hospitalier Universitaire de Grenoble-Alpes, GREPI EA7408 Université Grenoble-Alpes, F-38000 Grenoble, France
| | - Claire Roubaud-Baudron
- CHU Bordeaux, Pôle de Gérontologie Clinique, University of Bordeaux, INSERM 1312 BRIC, F-33000 Bordeaux, France
| | | | | | - Serge Alfandari
- Service Universitaire de Maladies Infectieuses et Tropicales, Hôpital Gustave Dron, F-59200 Tourcoing, France
| | - Hugues Aumaître
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Perpignan, F-66000 Perpignan, France
| | - Elisabeth Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, GIMAP (EA 3064), F-42055 Cedex 02 Saint-Etienne, France
- Faculty of Medicine of Saint-Etienne, University of Saint-Etienne, F-42023 Cedex 02 Saint-Etienne, France
- Faculty of Medicine, University of Lyon, F-69000 Lyon, France
| | - Pauline Caraux-Paz
- Service de Maladies Infectieuses et Tropicales, Hôpital Intercommunal de Villeneuve-Saint-Georges, F-94190 Villeneuve-Saint-Georges, France
| | - Alexandre Charmillon
- CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Grand Est Antibiotic Stewardship Network Coordinator, AntibioEst, F-54000 Nancy, France
| | - Sylvain Diamantis
- Service de Maladies Infectieuses et Tropicales, Hôpital de Melun, F-77000 Melun, France
- Unité de Recherche DYNAMIC, Université Paris-Est Créteil, F-94000 Créteil, France
| | - Thibaut Fraisse
- Court Séjour Gériatrique Aigu, Centre Hospitalier Alès-Cévennes, F-30100 Alès, France
| | - Pierre Gazeau
- Service des Maladies Infectieuses et Tropicales, CHRU de Brest, F-29609 Brest Cedex, France
| | - Maxime Hentzien
- Department of Internal Medicine, Infectious Diseases and Clinical Immunology, University Hospital of Reims, F-51100 Reims, France
- EA3797-Viellissement Fragilité, Reims Champagne Ardennes University, F-51100 Reims, France
| | - Jean-Philippe Lanoix
- AGIR UR 4294, University Picardie Jules Verne, F-80000 Amiens, France
- Department of Infectious Diseases, Amiens University Hospital, F-80000 Amiens, France
| | - Marc Paccalin
- Pôle de Gériatrie, CHU Poitiers, Université Poitiers, F-86000 Poitiers, France
- Centre d'Investigation Clinique CIC 1402, INSERM CHU Poitiers, Université Poitiers, F-86000 Poitiers, France
| | - Alain Putot
- Médecine Interne et Maladies Infectieuses, Hôpitaux du Pays du Mont Blanc, F-74700 Sallanches, France
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires, Université de Bourgogne, F-21000 Dijon, France
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University Hospital, F-67000 Strasbourg, France
| | - Eric Senneville
- Service Universitaire de Maladies Infectieuses et Tropicales, Hôpital Gustave Dron, F-59200 Tourcoing, France
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Pfister T, Schröder S, Heck J, Bleich S, Krüger THC, Wedegärtner F, Groh A, Schulze Westhoff M. Potentially inappropriate prescriptions of antibiotics in geriatric psychiatry-a retrospective cohort study. Front Psychiatry 2024; 14:1272695. [PMID: 38264634 PMCID: PMC10803574 DOI: 10.3389/fpsyt.2023.1272695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Older patients are frequently affected by infectious diseases and adverse drug reactions (ADRs) of consecutively prescribed antibiotics. Particularly within geriatric psychiatry, high rates of potentially inappropriate prescriptions (PIPs) have been described, significantly complicating pharmacological treatment. Therefore, this study aimed to investigate the frequency and characteristics of antibiotic PIPs in geriatric psychiatry. Methods Medication charts of 139 patient cases (mean age 78.8 years; 69.8% female) receiving antibiotic treatment on a geriatric psychiatric ward were analyzed. Utilizing previously published definitions of antibiotic PIPs, adequacy of the antibiotic prescriptions was subsequently assessed. Results 16.3% of all screened patient cases (139/851) received an antibiotic treatment during their inpatient stay. 59.5% of antibiotic prescriptions were due to urinary tract infections, followed by pulmonary (13.3%) and skin and soft tissue infections (11.3%). 46.7% of all antibiotic prescriptions fulfilled at least one PIP criterium, with the prescription of an antibiotic course for more than seven days as the most common PIP (15.3%). Discussion Antibiotic PIPs can be considered as a frequent phenomenon in geriatric psychiatry. Especially the use of fluoroquinolones and cephalosporins should be discussed critically due to their extensive side effect profiles. Due to the special characteristics of geriatric psychiatric patients, international guidelines on the use of antibiotics should consider frailty and psychotropic polypharmacy of this patient population more closely.
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Affiliation(s)
- Tabea Pfister
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tillmann H. C. Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Felix Wedegärtner
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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