Assessment of antibiotic prescriptions in pediatric care units in a regional university hospital.

OBJECTIVES: The main objective was to assess the relevance of antibiotic prescriptions in the pediatric wards of a regional university hospital in France. Secondary objectives were to assess adequacy of the dose, administration frequency, administration route, treatment duration, adaptation to bacteriological results, and treatment reevaluation. PATIENTS AND METHODS: We assessed antibiotic prescriptions in pediatric settings. We included all patients under 18 years of age hospitalized in a pediatric ward who received a computerized prescription for antibiotic treatment between June 1st and June 30th, 2018; 163 clinical cases for 157 patients were analyzed. Patients hospitalized in neonatology, pediatric intensive care unit, and onco-hematology wards were excluded. RESULTS: The rate of relevance was 71%. The rates of adequacy for the other criteria were 60% for the dose, 99% for the administration frequency, 98% for the administration route, 72% for treatment duration, 98% for treatment adaptation to microbiological results, and 100% for treatment revaluation. All criteria combined, the overall rate of adequacy was 28%. CONCLUSIONS: Effort should be made regarding doses and treatment durations. Areas for improvement have been suggested to the wards: standardized prescription protocols, pediatric prescription guide, training of residents, setting up of the operational team in pediatric wards and a second clinical evaluation.

D-dimer plasma measurement in patients undergoing major hip surgery: use in the prediction and diagnosis of postoperative proximal vein thrombosis.

Plasma D-Dimer (DD), a highly sensitive marker of venous thromboembolism, was measured with an ELISA assay preoperatively and on the 12th postoperative day in 173 patients undergoing major hip surgery (78 elective arthroplasties and 95 operations for fractures). Proximal deep venous thrombosis (DVT) was detected by systematic compression venous ultrasonography on the 12th postoperative day in 12 (7%) patients. In one additional case, proximal DVT was diagnosed by venography. Preoperative DD level was significantly higher in patients with fracture than in patients undergoing elective arthroplasty. At a cutoff of 500 micrograms/L as determined by ROC curve analysis, the sensitivity, specificity, positive and negative predictive values of the pre-operative DD concentration for the development of subsequent proximal DVT were 93%, 23%, 36% and 96%, respectively. The diagnostic exclusion value of the DD measurement on the 12th postoperative day was similar but for a cutoff of 2000 micrograms/L. These data suggest that plasma DD measurement might be useful to predict and diagnose proximal DVT following major hip surgery.

Screening for proximal deep venous thrombosis using B-mode venous ultrasonography following major hip surgery: implications for clinical management.

Despite antithrombotic prophylaxis, deep vein thrombosis (DVT) remains a frequent complication following major hip surgery. Most of the postoperative DVTs are asymptomatic but may result in fatal pulmonary embolism. Thus, detection of these events remains a clinical challenge. The present study evaluated prospectively the clinical usefulness of a systematic screening for proximal DVT in 173 consecutive patients undergoing major hip surgery and given systematic antithrombotic prophylaxis. On the 12th postoperative day, real-time B-mode ultrasonography of lower limbs veins detected 12 patients (7%) with proximal DVT. None of the individual or surgical characteristics of the patients could help to predict postoperative DVT. Because the sensitivity of ultrasonography for diagnosing DVT in asymptomatic patients may be low and because we did not screen for distal DVT, it was speculated that up to half proximal DVT and up to 75% of all DVT might have been missed by the screening. Therefore, low-dose oral anticoagulation with an INR 1.5-2.0 might be the most cost-effective modality in the postoperative period after the initial perioperative prophylaxis with low-dose heparin, low-molecular-weight heparins or intermittent pneumatic compression boots. Oral anticoagulant treatment might be continued for a total duration of 6 weeks, thereby also providing efficient therapy of undiagnosed distal DVT and prolonged for 3 months in patients with proximal DVT proven by systematic ultrasonographic screening at the time of discharge. The benefit-to-risk ratio of this management strategy deserves further evaluation in a specially designed, prospective trial.