Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team - 13/05/20
Évaluation de la pertinence des prescriptions de carbapénèmes par une équipe mobile d’antibiothérapie
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Highlights |
• | Five-month prospective study of carbapenem prescriptions in a University Hospital, with rapid responsiveness of the antibiotic stewardship team. |
• | An 82% compliance of carbapenem prescriptions with guidelines; better compliance for empirical prescriptions (91%). |
• | An almost systematic collection of microbiological samples in case of empirical prescriptions to promote de-escalation. |
• | Compliance of first prescribers with the infectious disease specialist's advice improving over the course of the study. |
• | Carbapenem treatment durations no longer than three days in 41% of cases, and no longer than seven days in 71% of cases. |
Abstract |
Objectives |
To assess the level and factors of compliance of carbapenem prescriptions with guidelines and to determine the impact of an antibiotic stewardship team in a university hospital.
Patients and methods |
Five-month prospective study in the intensive care, surgery, and medicine units to measure the compliance of carbapenem prescriptions with guidelines from French scientific societies; compliance was assessed by an infectious disease specialist warned by the pharmacy, and the prescribers’ compliance with the infectious disease specialist's advice was then assessed.
Results |
One hundred and four treatment initiations for 94 patients were included. Prescriptions were mostly empirical (64%), for pulmonary (35%), urinary tract (23%), and intra-abdominal (17%) infections. Prescriptions were mostly made in an intensive care unit (50%), by a junior physician (66%), with the use of imipenem (74%), and were followed by an objective reassessment (80%). Compliance with guidelines (82%) was significantly higher for empirical than documented prescriptions (91% vs 65%, P<0.001). Compliance was higher in intensive care units than medicine units (87% vs 61%, P=0.037). No change in the compliance rate was observed during the study. Compliance with the infectious disease specialist's advice (68%) improved, although not significantly (P=0.066).
Conclusions |
Because of a higher than expected compliance of carbapenem prescriptions with guidelines and a lower than expected inclusions in the study, we did not show any impact. The diffusion of guidelines and long-term control of carbapenem prescriptions seem to be possible and necessary in hospitals to limit their ecological impact.
Il testo completo di questo articolo è disponibile in PDF.Résumé |
Objectifs |
Évaluer le niveau et les facteurs de conformité des prescriptions de carbapénèmes à un référentiel et l’impact d’une équipe mobile d’antibiothérapie dans un centre hospitalier universitaire.
Patients et méthodes |
Étude prospective de cinq mois en réanimation, chirurgie et médecine sur la conformité des prescriptions de carbapénèmes aux recommandations de la société savante française, évaluée par un infectiologue alerté par la pharmacie, suivie d’une évaluation de l’adhésion des prescripteurs aux avis infectiologiques.
Résultats |
Cent-quatre instaurations de traitement pour 94 patients ont été incluses. Les prescriptions étaient majoritairement probabilistes (64 %), pour des infections pulmonaires (35 %), urinaires (23 %) et intra-abdominales (17 %). Elles étaient principalement instaurées en réanimation (50 %), par un interne (66 %), avec recours à l’imipénème (74 %) et suivie d’une réévaluation objectivable (80 %). La conformité au référentiel (82 %) était significativement meilleure pour les prescriptions probabilistes que pour les documentées (91 % vs 65 %, p<0,001), et dans les services de réanimation que de médecine (87 % vs 61 %, p=0,037). Aucune évolution du taux de conformité n’a été observée durant l’étude. L’adhésion aux avis infectiologiques (68 %) s’est améliorée non significativement (p=0,066).
Conclusion |
En raison de la conformité plus élevée qu’attendue des prescriptions de carbapénèmes et des inclusions moins nombreuses que prévues, aucun impact n’a été démontré. La diffusion d’un référentiel et un contrôle pérenne des prescriptions de carbapénèmes sont possibles et nécessaires dans les hôpitaux pour limiter leur impact écologique.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Antibiotic stewardship, Beta-lactamases, Carbapenems
Mots clés : Bêta-lactamases, Bon usage des antibiotiques, Carbapénèmes
Mappa
| ☆ | This study was presented as a poster at the RICAI (Réunion Interdisciplinaire de Chimiothérapie Anti-Infectieuse) in December 2017, Paris. |
Vol 50 - N° 4
P. 346-351 - Giugno 2020 Ritorno al numero
Articolo precedente
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- C. Bolla, C. Di Pietrantonj, E. Ferrando, A. Pernecco, A. Salerno, M. D’Orsi, G. Chichino
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