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Sakly H, Rebaia F, Ben Jeddou K. [Antibiotic therapy in hospitals: Evaluation of antibiotic prescriptions and determination of factors influencing relevance]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:478-485. [PMID: 34425079 DOI: 10.1016/j.pharma.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/29/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the relevance and compliance of antibiotic prescriptions made in a Tunisian hospital and study the factors likely to influence them. METHODS This is a cross-sectional, monocentric study of antibiotic prescriptions belonging to the Watch and Reserve Groups of the World Health Organization's AWaRe classification, between January 1 and February 29, 2020. RESULTS A total of 310 antibiotic prescriptions were analyzed. Monotherapy represented 89,7 % of prescriptions. The most prescribed molecule was cefotaxime (42,8%). Antibiotic therapy was documented in 13% of cases. The antibiotic prescriptions were rational in 14,5% of cases. One third of prescriptions were irrelevant and 4,8% not justified. The dominant ground for non-compliance was unsuitable duration. The status of the prescriber and the prescribing service were factors influencing the relevance of prescriptions. CONCLUSION Irrational use of antibiotics was common in this study. As a result, the establishment of an antibiotic therapy guide and a computerized decision-support tool seem essential to guarantee the quality of antibiotic prescriptions.
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Affiliation(s)
- H Sakly
- Service de pharmacie, hôpital Universitaire de Bizerte, Tunisie; Faculté de Pharmacie de Monastir, université de Monastir, Tunisie.
| | - F Rebaia
- Service de pharmacie, hôpital Universitaire de Bizerte, Tunisie
| | - K Ben Jeddou
- Service de pharmacie, hôpital Universitaire de Bizerte, Tunisie; Faculté de Pharmacie de Monastir, université de Monastir, Tunisie
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Michno M, Sydor A, Wałaszek M, Sułowicz W. Microbiology and Drug Resistance of Pathogens in Patients Hospitalized at the Nephrology Department in the South of Poland. Pol J Microbiol 2019; 67:517-524. [PMID: 30550238 PMCID: PMC7256703 DOI: 10.21307/pjm-2018-061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 11/30/2022] Open
Abstract
A retrospective study was conducted among 498 patients with urinary tract infections (UTI) referred to our department from January 2013 to December 2015. This study was performed to evaluate the etiology of UTI and the antibiotic susceptibility profile of Escherichia coli (E. coli) as the main etiological factor in different age groups. Urine samples were examined using standard microbiological methods. Three hundred sixty-three samples (72.9%) were identified as E. coli, of which 29 (8.0%) can produce extended-spectrum β-lactamases (ESBL). E. coli was highly sensitive to imipenem (100.0%), gentamicin (91.0%), nitrofurantoin (89.4%), amikacin (88.2%), piperacillin/tazobactam (87.0%) and cephalosporins (79.7–89.5%). Low sensitivity was found in relation to fluoroquinolones (60.3–70.4%). E. coli was least sensitive to ampicillin (30.2%) and amoxicillin/clavulanic acid (49.9%). We observed a significant fall in susceptibility level to piperacillin/tazobactam (68.4% vs. 88.8%; p = 0.017), amikacin (61.1% vs. 90.7%; p = 0.001), gentamicin (70.0% vs. 93.2%; p = 0.002), cefalexin (41.2% vs. 83.3%; p < 0.001), cefotaxime (63.6% vs. 89.4%; p = 0.002), ceftazidime (61.9% vs. 85.6%; p = 0.008), cefepime (73.7% vs. 91.1%; p = 0.025), ciprofloxacin (54.1% vs. 72.2%; p = 0.024) and norfloxacin (40.5% vs. 62.5%; p = 0.011) among patients with catheter-associated UTI (CAUTI) compared to those with non-CAUTI. A similar susceptibility profile was observed between different age groups. In the longevity, E. coli showed a higher sensitivity to cephalosporins than in the young-old group. E. coli susceptibility to fluoroquinolones was low, which excludes them as a first-line drug in our department. Nitrofurantoin may be used as an alternative drug to carbapenems. Monitoring of susceptibility pattern is of great importance.
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Affiliation(s)
- Mikołaj Michno
- Department of Internal Medicine, Nephrology and Dialysis Centre, Regional St Lukas Hospital , Tarnów , Poland
| | - Antoni Sydor
- Department of Internal Medicine, Nephrology and Dialysis Centre, Regional St Lukas Hospital , Tarnów , Poland
| | | | - Władysław Sułowicz
- Chair and Department of Nephrology, Jagiellonian University , Cracow , Poland
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Bérard L. Évaluation de la qualité de la prescription d’antibiotiques dans les infections urinaires de l’adulte au service d’urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2018-0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectifs : De nombreux traitements anti-infectieux sont débutés dans les services d’urgences (SU). Nous avons étudié la qualité de la prescription d’antibiotiques dans le traitement probabiliste des infections urinaires (IU) au SU d’un centre hospitalier général français.
Matériels et méthodes : Nous avons conduit une étude rétrospective monocentrique du 1er janvier au 30 juin 2017. Tous les patients pour lesquels une IU a été diagnostiquée au SU ont été inclus. Les traitements hospitaliers et ambulatoires des IU ont été analysés au regard des recommandations de 2015 de la Société d’infectiologie française. Le critère principal d’évaluation a été le classement des antibiothérapies probabilistes en deux catégories : « conforme » ou « non conforme » à ce référentiel. Le critère secondaire d’évaluation a été l’adéquation du traitement antibiotique initial à la sensibilité des souches bactériennes identifiées.
Résultats : Cent quatre-vingt-onze patients ont été inclus : 99 pyélonéphrites (52 %), 18 prostatites (9 %), 48 cystites (25 %) et 26 infections urinaires de siège non précisé (14 %). L’âge moyen a été de 52 ans avec 26 % d’hommes et 74 % de femmes. Au total, 114 antibiothérapies (60 %) ont été considérées conformes aux recommandations. Des antibiotiques ont été prescrits par excès dans 35 cas. La souche identifiée n’était pas sensible au traitement instauré au SU dans neuf situations.
Conclusion : Cette étude met en exergue les difficultés pour la mise en application des recommandations en thérapeutique anti-infectieuse au SU dans 40 % des situations. Un rappel et une évaluation continue des bonnes pratiques de prescription des antibiotiques au SU sont nécessaires.
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Flokas ME, Andreatos N, Alevizakos M, Kalbasi A, Onur P, Mylonakis E. Inappropriate Management of Asymptomatic Patients With Positive Urine Cultures: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2017; 4:ofx207. [PMID: 29226170 PMCID: PMC5714225 DOI: 10.1093/ofid/ofx207] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/22/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Mismanagement of asymptomatic patients with positive urine cultures (referred to as asymptomatic bacteriuria [ASB] in the literature) promotes antimicrobial resistance and results in unnecessary antimicrobial-related adverse events and increased health care costs. METHODS We conducted a systematic review and meta-analysis of studies that reported on the rate of inappropriate ASB treatment published from 2004 to August 2016. The appropriateness of antimicrobial administration was based on guidelines published by the Infectious Diseases Society of America. RESULTS A total of 2142 nonduplicate articles were identified, and among them 30 fulfilled our inclusion criteria. The pooled prevalence of antimicrobial treatment among 4129 cases who did not require treatment was 45% (95% CI, 39-50). Isolation of gram-negative pathogens (odds ratio [OR], 3.58; 95% CI, 2.12-6.06), pyuria (OR, 2.83; 95% CI, 1.9-4.22), nitrite positivity (OR, 3.83; 95% CI, 2.24-6.54), and female sex (OR, 2.11; 95% CI, 1.46-3.06) increased the odds of receiving treatment. The rates of treatment were higher in studies with ≥100 000 cfu/mL cutoff values compared with <10 000 cfu/mL for bacterial growth (P, .011). The implementation of educational and organizational interventions designed to eliminate the overtreatment of ASB resulted in a median absolute risk reduction of 33% (rangeARR, 16-36%, medianRRR, 53%; rangeRRR, 25-80%). CONCLUSION The mismanagement of ASB remains extremely frequent. Female sex and the overinterpretation of certain laboratory data (positive nitrites, pyuria, isolation of gram-negative bacteria and cultures with higher microbial count) are associated with overtreatment. Even simple stewardship interventions can be particularly effective, and antimicrobial stewardship programs should focus on the challenge of differentiating true urinary tract infection from ASB.
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Affiliation(s)
- Myrto Eleni Flokas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Nikolaos Andreatos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Michail Alevizakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Alireza Kalbasi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Pelin Onur
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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Rochefolle A, Maison O, Chazaud C, Rioufol C, Rode G, Luaute J, Jacquin-Courtois S, Guinet-Lacoste A, Carré E. [Impact of pharmaceutical interventions on antibiotic therapy of urinary tract infections in rehabilitation center]. Prog Urol 2017; 27:439-445. [PMID: 28576426 DOI: 10.1016/j.purol.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 04/17/2017] [Accepted: 04/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of medico-pharmaceutical partnership on the quality of antibiotic treatment in urinary tract infection (UTI) within rehabilitation center. MATERIAL All antibiotic prescriptions were validated by the pharmacist at the start of treatment and twice a week. All patients with symptomatic urinary tract infection between January 1, 2014 to December 31, 2015 were included in this study. Addition to awareness among specifiers to promoting the appropriate use of antibiotics, the pharmacist suggested pharmaceutical interventions (PI) in order to improve the quality of antibiotic treatments. At the same time, 3 quality indicators (QI) were followed: duration, dosage, antibiotic susceptibility. The compliance rates of this 3 QI allowed to assess the quality of the antibiotic treatment in urinary tract infection. RESULTS The study population included 154 patients corresponding to 252 UTI. Sixty-eight PI were made by pharmacist about urinary tract infection treatment (overdosage or under-dosing, duration unknown, inadequate route of administration). These QI achieved 96.4% compliance with duration, 98.8% compliance with dosage and 99.2% with the antibiotic susceptibility. CONCLUSION This study allowed showing the medico-pharmaceutical impact on the quality of antibiotic treatments in UTI. The awareness among specifiers with a daily validation of prescription by the pharmacist allowed to improve urinary tract infections care in rehabilitation center. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Rochefolle
- Service pharmaceutique groupement hospitalier Sud, hospices civils de Lyon (HCL), 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - O Maison
- Service pharmaceutique groupement hospitalier Sud, hospices civils de Lyon (HCL), 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - C Chazaud
- Service pharmaceutique groupement hospitalier Sud, hospices civils de Lyon (HCL), 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | - C Rioufol
- Service pharmaceutique groupement hospitalier Sud, hospices civils de Lyon (HCL), 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Lyon 1,EMR 3738, Lyon, France.
| | - G Rode
- Service de médecine physique et réadaptation neurologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, centre de recherche en neurosciences de Lyon, université Lyon 1, Lyon, France.
| | - J Luaute
- Service de médecine physique et réadaptation neurologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, centre de recherche en neurosciences de Lyon, université Lyon 1, Lyon, France.
| | - S Jacquin-Courtois
- Service de médecine physique et réadaptation neurologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France; Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, centre de recherche en neurosciences de Lyon, université Lyon 1, Lyon, France.
| | - A Guinet-Lacoste
- Service de médecine physique et réadaptation neurologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
| | - E Carré
- Service pharmaceutique groupement hospitalier Sud, hospices civils de Lyon (HCL), 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
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Amoxicillin-clavulanic acid prescriptions at the Greater Paris University Hospitals (AP-HP). Med Mal Infect 2016; 47:42-49. [PMID: 27765474 DOI: 10.1016/j.medmal.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 04/01/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We aimed to document amoxicillin-clavulanic acid prescription to improve the proper use of antibiotics in hospital settings. We used three criteria: quality of medical charts, adequacy of indications, and adequacy of treatment duration. METHOD This study was designed as a one-day point prevalence survey carried out by antibiotic lead specialists. RESULTS We included 387 prescriptions from 32 hospitals. Immunodeficiency was recorded as a risk factor in 30% of patients. Computerized prescriptions were observed in 79% of cases. The indication was mentioned in 73% of cases and a 48/78-hour re-assessment of the antibiotic therapy was performed in 54% of cases. The antibiotic indication was primarily for pneumonia and was deemed appropriate in 75% of patients. Adult mean treatment duration was 11.1 days. Use of dual combination therapy and/or treatment duration exceeding two weeks accounted for the main reasons for an inappropriate use of antibiotics. Prescriptions recorded as having been made by senior physicians were of the shortest treatment duration (P=0.0163). CONCLUSION Medical charts should be better filled in. Reinforcing the role of senior physicians in supervising antibiotic prescriptions is likely to result in a better control of treatment duration and ultimately in a reduced antibiotic consumption. By reinforcing the collaboration between pharmacists and antibiotic lead specialists, the improvement of computerized prescriptions at hospital level should help better detect the "at risk" prescriptions, namely those exceeding seven days or those combining antibiotics.
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Évaluation de la qualité de l’antibiothérapie des infections urinaires dans le service de médecine polyvalente post-urgence du CHRU de Lille : une étude de cohorte rétrospective. Rev Med Interne 2015; 36:728-37. [DOI: 10.1016/j.revmed.2015.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 06/08/2015] [Accepted: 07/28/2015] [Indexed: 11/30/2022]
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Miclot C, Antoniotti G, Forestier E. Study of family physicians' practices in case of urinary tract infections caused by enterobacteriaceae secreting extended-spectrum-beta-lactamase. Med Mal Infect 2015; 45:78-83. [PMID: 25676475 DOI: 10.1016/j.medmal.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/13/2014] [Accepted: 01/13/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Urinary tract infections caused by enterobacteriaceae secreting extended-spectrum beta-lactamase (EESBL) is an issue for most family physicians. The aim of our study was to evaluate their practice in case of EESBL discovered after urinalysis and culture (U/C). MATERIAL AND METHODS This epidemiological and retrospective study was conducted from the January 1, to December 31, 2012, in 5 laboratories of Savoie and Isere. Results of U/C prescribed by family physicians and positive for EESBL were collected. The data collected with questionnaires, concerned characteristics of the infection, antibiotic treatment adequateness, the implementation of specific hygiene measures, and risk factors for EESBL infection. RESULTS One hundred and three U/C out of 19,494 were considered, and 56 questionnaires were collected. The rate of EESBL positive U/C was 0.60%. The antibiotic treatment was adequate for 35 patients (62.5%). Specific hygiene measures were implemented for 22 patients (32.3%). Both antibiotic treatment and specific hygiene measures were initiated for 13 patients (23.2%). Fourteen cases of community-acquired infections (25%) were reported. Five patients (8.9%) had traveled to an endemic zone in the previous 6 months. CONCLUSION The concomitant initiation of both antibiotic treatment and specific hygiene measures in case of U/C positive for EESBL is insufficient when managed by family physicians. It could be improved by offering tools for the management of these infections, by developing EESBL networks between hospital and family physicians, and epidemiological surveillance in community settings.
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Affiliation(s)
- C Miclot
- Les terrasses de Bonne, 4, rue des Jardins, 05000 Gap, France.
| | - G Antoniotti
- Laboratoire d'analyses médicales Bio Médica, Labazur, 7, rue Davat, 73100 Aix-les-Bains, France.
| | - E Forestier
- Service de maladies infectieuses et de médecine interne, centre hospitalier de Chambéry, place Lucien-Biset, BP 31125, 73011 Chambéry cedex, France.
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Piljic D, Porobic-Jahic H, Piljic D, Ahmetagic S, Jahic R. Chateter-associated Urinary Tract Infections in Adults. Mater Sociomed 2013; 25:182-6. [PMID: 24167432 PMCID: PMC3804418 DOI: 10.5455/msm.2013.25.182-186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/05/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Hospital-acquired Urinary tract infections make 35% of all the hospital-acquired infections, and about 80% of them are related to the catheterization of the urinary bladder. PURPOSE To determine clinical characteristics and dominant etiologic factors of Urinary Tract Infections associated with urinary catheter (C-UTIs). METHODS Determined clinical characteristics of C-UTIs were prospectively analyzed on 38 hospitalized patients in the Clinic for Infectious Diseases at the University Clinical Centre Tuzla, from January 1(st) 2011 to December 31(st) 2011. The control group constituted of 200 patients with community-acquired Urinary Tract Infections (Co-UTIs) hospitalized in the same period. RESULTS It was registered on 22 (57.89%) of symptomatic infections, 14 (36.84%) asymptomatic bacteriuria and 2 (5.26%) other C-UTIs. Dominant etiologic factors were: E. coli, caused 14 (36.84%), Extended-Spectrum Beta-lactamase producing (ESBL) Klebsiella pneumoniae 7 (18.42%), Enterococcus faecium and Candida spp. 3 (7.89%) of C-UTIs. E. coli was significantly most common etiologic factor of C-UTIs in younger women (p=0.04). E. coli from C-UTIS showed significantly higher resistance to antimicrobial drugs. Inadequate antimicrobial therapy was significantly more common prescribed to patients from C-UTIs. Lethal outcome was significantly most common associated with certain clinical and laboratory findings. CONCLUSION Initial antimicrobial therapy of those serious infections should be based on data from those research.
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Affiliation(s)
- Dilista Piljic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Humera Porobic-Jahic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Dragan Piljic
- Clinic for Cardiovascular Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sead Ahmetagic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Rahima Jahic
- Clinic for Infectious Diseases, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Audit des prescriptions d’antibiotiques dans les pneumonies aiguës communautaires de l’adulte dans un centre hospitalier universitaire. Med Mal Infect 2010; 40:468-75. [DOI: 10.1016/j.medmal.2010.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 12/17/2009] [Accepted: 01/07/2010] [Indexed: 11/21/2022]
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Velasco Arribas M, Rubio Cirilo L, Casas Martín A, Martín Sánchez M, Gamez Díez S, Delgado-Iribarren A, Valverde Cánovas J, García de Casasola G. Adecuación del tratamiento empírico de la infección urinaria en urgencias. Rev Clin Esp 2010; 210:11-6. [DOI: 10.1016/j.rce.2009.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 06/29/2009] [Indexed: 11/17/2022]
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Dupont C, Massé C, Auvert B, Page B, Heym B, Espinasse F, Hanslik T, Rouveix E. [Evaluation of amoxicillin-clavulanic acid prescriptions in a teaching hospital of Parisian suburb]. Rev Med Interne 2008; 29:195-9. [PMID: 18191002 DOI: 10.1016/j.revmed.2007.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/10/2007] [Accepted: 11/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Prospective study of amoxicillin-clavulanic acid (amox-clav) prescriptions in the medical departments of a teaching hospital that prescribes this antibiotic very often. DESIGN From April to May 2004, each patient treated by amox-clav was included. Data were collected (age, sex, past diseases, associated-diseases, reason for hospitalization, prior antibiotic therapy, date of amox-clav prescription, indication for amox-clav prescription, other associated antibiotics, nosocomial or community-acquired infection, site of infection, bacteriologic samples and bacterial identification, treatment duration and status of the physician). Data were analysed by a muldisciplinary group and compared with a referential used for antibiotic prescriptions in our hospital. RESULTS One hundred and two medical files were analysed. Seventy-one percent of amox-clav prescriptions were in adequation with the referential. Combination of three criteria (indication of antibiotic therapy, choice of amox-clav and of an antibiotic combination) showed that 58 (57%) was acceptable, 29 (28%) was debatable and 15 (15%) was unacceptable. Unacceptable prescriptions were often made by a junior. The majority of inadequate antibiotic prescriptions referred to acute pulmonary infections. Antibiotic combinations were often inadequate and treatment duration was too long. The quality of the prescription was more accurate when made by a senior. CONCLUSION An effort should be made in our teaching hospital to optimize antibiotic prescriptions.
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Affiliation(s)
- C Dupont
- Service de médecine interne-2, CHU Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne cedex, France.
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Alfandari S, Baudlot I, Caillaux M, Senneville E, Thirard L, Zawadzki E, Leroy O. [Compliance to the antibiotic committee guidelines in Tourcoing Hospital]. PATHOLOGIE-BIOLOGIE 2007; 55:486-9. [PMID: 17920785 DOI: 10.1016/j.patbio.2007.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
AIMS OF THE STUDY We evaluated the compliance to the antibiotic committee guidelines of Tourcoing Hospital. METHODS A national nosocomial infections prevalence study was conducted in June 2006. We collected additional data on the name and indication of prescribed antibiotics compared to recommended drugs in our therapeutic guidelines. Endpoints were antibiotic indication, compliance to local guidelines, unjustified combination therapy and deescalation therapy if possible. Situations non included in the guidelines were evaluated on a case to case basis after discussion with the prescribing physician. Pediatric (N=5) or prophylaxis (N=4) prescriptions were not analysed. RESULTS Antibiotics were used in 97/669 (14.5%) patients including 32% in acute care, 11% in rehab and 0,9% in long term care. Drugs recommended in the guidelines were used in 63 cases (60.5%) including 56.3% first line and 4.2% justified second line therapy. When including situations not included in the guidelines and judged as correct, compliance reached 64.9%. The 41 variations from guidelines observed in 34 patients concerned: molecule choice (N=12), lack of antibiotic indication (N=12), unjustified combination therapy (N=12), drug choice in combination therapy (N=5), lack of deescalation (N=1). Lower respiratory tract (N=12) and urinary tract (N=7) infections as well as fluoroquinolones (N=12) were the most frequent deviations from guidelines. CONCLUSION Compliance rate is encouraging. This study pinpoints specific targets for future interventions.
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Affiliation(s)
- S Alfandari
- Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, France.
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