Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team
•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 mic...
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| Veröffentlicht in: | Médecine et maladies infectieuses 2020-06, Vol.50 (4), p.346-351 |
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| creator | Perron, J. Baldolli, A. Isnard, C. de La Blanchardière, A. Saint-Lorant, G. |
| description | •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.
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.
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.
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 |
| doi_str_mv | 10.1016/j.medmal.2019.06.004 |
| format | Article |
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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.
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.
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).
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.
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.
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.
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).
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.</description><identifier>ISSN: 0399-077X</identifier><identifier>EISSN: 1769-6690</identifier><identifier>DOI: 10.1016/j.medmal.2019.06.004</identifier><identifier>PMID: 31257064</identifier><language>eng</language><publisher>France: Elsevier Masson SAS</publisher><subject>Antibiotic stewardship ; Antibiotics ; Beta-lactamases ; Bon usage des antibiotiques ; Bêta-lactamases ; Carbapenems ; Carbapénèmes ; Compliance ; Diffusion ; Guidelines ; Hospitals ; Imipenem ; Inclusions ; Infections ; Infectious diseases ; Intensive care ; Intensive care units ; Medicine ; Patients ; Surgery ; Urinary tract</subject><ispartof>Médecine et maladies infectieuses, 2020-06, Vol.50 (4), p.346-351</ispartof><rights>2019 Elsevier Masson SAS</rights><rights>Copyright © 2019 Elsevier Masson SAS. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Jun 2020</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-939630fb9482bfeb10fcc209fb7c132f6871ab19faf337b4ed9ee378f032440b3</citedby><cites>FETCH-LOGICAL-c390t-939630fb9482bfeb10fcc209fb7c132f6871ab19faf337b4ed9ee378f032440b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.medmal.2019.06.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31257064$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perron, J.</creatorcontrib><creatorcontrib>Baldolli, A.</creatorcontrib><creatorcontrib>Isnard, C.</creatorcontrib><creatorcontrib>de La Blanchardière, A.</creatorcontrib><creatorcontrib>Saint-Lorant, G.</creatorcontrib><title>Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team</title><title>Médecine et maladies infectieuses</title><addtitle>Med Mal Infect</addtitle><description>•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.
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.
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.
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).
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.
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.
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.
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).
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.</description><subject>Antibiotic stewardship</subject><subject>Antibiotics</subject><subject>Beta-lactamases</subject><subject>Bon usage des antibiotiques</subject><subject>Bêta-lactamases</subject><subject>Carbapenems</subject><subject>Carbapénèmes</subject><subject>Compliance</subject><subject>Diffusion</subject><subject>Guidelines</subject><subject>Hospitals</subject><subject>Imipenem</subject><subject>Inclusions</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Intensive care</subject><subject>Intensive care units</subject><subject>Medicine</subject><subject>Patients</subject><subject>Surgery</subject><subject>Urinary tract</subject><issn>0399-077X</issn><issn>1769-6690</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LXTEQhoO06K36D0oJdNPNOZ18nJybjSDSLxC6qdBdSHImNZfzZZKr-O8budaFi8LALOaZd4aHkPcMWgZMfd61Ew6THVsOTLegWgB5RDasV7pRSsMbsgGhdQN9__uEvMt5B8ArC8fkRDDe9aDkhtxc5ow5x_kPLbdIE454b2ePdAnU2-TsijNOdE2YfYpricucqXukdq5VootLiZ7mgg82Dfk2rrSgnc7I22DHjOfP_ZTcfP3y6-p7c_3z24-ry-vGCw2l0UIrAcFpueUuoGMQvOegg-s9Ezyobc-sYzrYIETvJA4aUfTbAIJLCU6ckk-H3DUtd3vMxUwxexxHO-Oyz4bzDpToOqYr-vEVulv2aa7fGS67GqplpyolD5RPS84Jg1lTnGx6NAzMk3azMwft5km7AWWq9rr24Tl87-r4Zemf5wpcHACsNu4jJpN9xOp5iAl9McMS_3_hL8BjlaQ</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Perron, J.</creator><creator>Baldolli, A.</creator><creator>Isnard, C.</creator><creator>de La Blanchardière, A.</creator><creator>Saint-Lorant, G.</creator><general>Elsevier Masson SAS</general><general>Elsevier Science Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T5</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>202006</creationdate><title>Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team</title><author>Perron, J. ; Baldolli, A. ; Isnard, C. ; de La Blanchardière, A. ; Saint-Lorant, G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-939630fb9482bfeb10fcc209fb7c132f6871ab19faf337b4ed9ee378f032440b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antibiotic stewardship</topic><topic>Antibiotics</topic><topic>Beta-lactamases</topic><topic>Bon usage des antibiotiques</topic><topic>Bêta-lactamases</topic><topic>Carbapenems</topic><topic>Carbapénèmes</topic><topic>Compliance</topic><topic>Diffusion</topic><topic>Guidelines</topic><topic>Hospitals</topic><topic>Imipenem</topic><topic>Inclusions</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Intensive care</topic><topic>Intensive care units</topic><topic>Medicine</topic><topic>Patients</topic><topic>Surgery</topic><topic>Urinary tract</topic><toplevel>online_resources</toplevel><creatorcontrib>Perron, J.</creatorcontrib><creatorcontrib>Baldolli, A.</creatorcontrib><creatorcontrib>Isnard, C.</creatorcontrib><creatorcontrib>de La Blanchardière, A.</creatorcontrib><creatorcontrib>Saint-Lorant, G.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Médecine et maladies infectieuses</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perron, J.</au><au>Baldolli, A.</au><au>Isnard, C.</au><au>de La Blanchardière, A.</au><au>Saint-Lorant, G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team</atitle><jtitle>Médecine et maladies infectieuses</jtitle><addtitle>Med Mal Infect</addtitle><date>2020-06</date><risdate>2020</risdate><volume>50</volume><issue>4</issue><spage>346</spage><epage>351</epage><pages>346-351</pages><issn>0399-077X</issn><eissn>1769-6690</eissn><abstract>•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.
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.
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.
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).
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.
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.
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.
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).
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.</abstract><cop>France</cop><pub>Elsevier Masson SAS</pub><pmid>31257064</pmid><doi>10.1016/j.medmal.2019.06.004</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0399-077X |
| ispartof | Médecine et maladies infectieuses, 2020-06, Vol.50 (4), p.346-351 |
| issn | 0399-077X 1769-6690 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2250635519 |
| source | ScienceDirect Journals (5 years ago - present) |
| subjects | Antibiotic stewardship Antibiotics Beta-lactamases Bon usage des antibiotiques Bêta-lactamases Carbapenems Carbapénèmes Compliance Diffusion Guidelines Hospitals Imipenem Inclusions Infections Infectious diseases Intensive care Intensive care units Medicine Patients Surgery Urinary tract |
| title | Assessing the relevance of carbapenem prescriptions by an antibiotic stewardship team |
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