Factors associated with effective reassessment of antibiotic therapy on day 3.

UNLABELLED: Reassessment of antibiotic therapy (RA) after 3 days is constitutive of French antibiotic stewardship. This delay is required because of the need for clinical reappraisal and for obtaining microbiological data. Our aim was to determine the factors associated with an effective RA. PATIENTS AND METHOD: A prospective study was made in a 350-bed general hospital in which all prescriptions are computerized and validated daily by prescribers. All curative antibiotic therapies were reassessed during 4 weeks. RA was defined as effective if the initial antibiotic treatment was modified. All clinical, biological, and radiological data having contributed to the initial prescription and to RA were recorded during bedside visit with the prescribers, two hospital physicians and one infectious diseases specialist. RESULTS: In one month, 148 antibiotic treatments were reassessed. Pulmonary, digestive, and urinary infections accounted for two thirds of the cases. An effective RA was recorded in 28 cases (19%) and associated with hospitalization in the ICU (P=0.001), imaging supporting the diagnosis (P=0.016), and persistence or aggravation of clinical signs (P=0.007). Microbiological findings were not contributive to an effective RA. CONCLUSION: RA was associated to hospitalization in the ICU, to an inflammatory syndrome, and to the clinical outcome after 3 days. These results should help to improve the implementation of infectious diseases advice.

[Prospective evaluation of antibiotic combinations in a general hospital]. / Evaluation prospective des associations antibiotiques d'un centre hospitalier général.

INTRODUCTION: We previously reported a 30% rate of inadequate antibiotic therapy in a general hospital with optimal organization. This data led to implement a systematic weekly infectious diseases consultation. We report an evaluation of antibiotic combinations. PATIENTS AND METHODS: The infectious diseases consultation was scheduled half-a-day per week. Antibiotic combinations were collected by the pharmacist via computerized prescriptions. Discussion with the managing physician was systematic in order to evaluate the adequacy of the treatment both in terms of diagnosis and therapy. RESULTS: For 9 months, 381 patients were prescribed 486 antibiotic combinations, among which 116 were evaluated. The infectious diseases specialist suggested a similar diagnosis in 71 antibiotic treatments (61%), the diagnosis appeared doubtful in 36 cases (31%), and a true diagnostic discordance was noted in nine cases. The discussion between specialist and managing physician suggested that the antibiotic combination was justified in 35%, of limited usefulness in 22%, and inadequate in 43% of the cases. There was a significant correlation between the result of the discussion and the accuracy of the antibiotic combination (p<0.001). Respiratory infections were the main reason for inadequate or limited usefulness of antibiotic combinations (30/49, 61%). CONCLUSION: Computerized prescriptions allow the evaluation of antibiotic therapy even when the infectious diseases specialist intervention is short. The discussion with the managing physician on diagnosis and treatment appears to play a central role for a better use of antibiotherapy.