[The interest and assessment of the application of antibiotic protocols in a department of pneumology]. / Intérêt et évaluation de l'application de protocoles d'antibiothérapie dans un service de pneumologie.

OBJECTIVE: To assess whether antibiotic prescriptions in a department of pneumology are in accordance with the hospital conventions and whether documented prescriptions and probabilistic prescriptions are correctly adapted with regard to microbiological results and clinical progression of patients. METHOD: A 3-month prospective observational study was performed from november 1999 to january 2000 in a department of pneumology on all antibiotic prescriptions. The referential used for the conformity of probabilistic was the guide to pneumology antibiotic protocols regarding the most frequently encountered diseases. Treatment was considered adapted if the choice of the molecule and the dose administered were effective. Documented antibiotherapy was considered appropriate if the dose was correct and/or the micro-organisms were sensitive to at least one of the molecules administered. Probabilistic treatment was considered appropriated if progression was good without any change in the antibiotics. RESULTS: Among the 404 patients hospitalised in Pneumology, 132 (33%) received at least one antibiotherapy. There was a total of 163 treatments, 142 (87%) of which were probabilistic and 21 were documented. Seventy-two percent of the probabilistic prescriptions were in accordance with the protocols. The majority of those which did not conform (60.5%) was due to the dose rather than the choice of the antibiotic. More than three quarters of the probabilistic and documented treatments (79%) were clinically adapted. Treatment failures were more often due to a mistake in spectrum rather than an inappropriate dose. CONCLUSION: The use of antibiotics has become increasingly complex because of the need for therapeutic efficacy, limitation of the selection of microbial resistance, and the cost of treatment. Application of antibiotic protocols drawn-up by the clinicians, microbiologists and chemists concerned appears to be an efficient solution that is clearly acceptable to the various participants.

[Screening and follow-up of nosocomial infections by multiresistant bacteria using the Bacterio software. Microbiology laboratory data]. / Dépistage et suivi des infections nosocomiales à bactéries multirésistantes à l'aide du logiciel Bacterio. Données du laboratoire de microbiologie.

OBJECTIVE: To study the relationship between the prevalence of multi-resistant bacteria (MRB) and nosocomial MRB infections. METHOD: This work presents the results of a follow up of hospital-acquired infections due to multidrug-resistant bacteria (MRB), based on microbiology detection with the Bacterio software and clinical confirmation. RESULTS: Clinical responses reached 93%. During the year 2000, the incidence of hospital-acquired MRB infections was 1.23 for 1000 hospitalization days and 1.00 for 100 admissions. Ticarcilline-resistant P. aeruginosa were responsible for 32% of hospital-acquired MRB infections. The incidence curve of MRB colonization was parallel with that of hospital-acquired infections. Hence, the incidence of MRB colonization is a rapid and good means of assessing the best probabilistic antibiotherapy especially in intensive care units. COMMENTS: Examination of medical records is however necessary to obtain complementary clinical information on: risk factors, use of medical devices, medical or chirurgical antecedents and prior antibiotherapy. The easiness of detection and management of hospital-acquired infections allowed us to extend its use in 2001 to the follow-up of all hospital-acquired infections, with or without MRB. Bacterio is also able to detect the hospital-acquired infections that, according to the recent decree (No. 2001-671, july 30th, 2001), must be declared to the sanitary authorities. Such suspicions should then be validated by the clinicians and the practising hygienist.

[Monitoring the incidence of multidrug-resistant bacteria in microbiology laboratories using Bacterio software]. / L'apport du laboratoire de microbiologie au suivi de l'incidence des bactéries multirésistantes à l'aide du logiciel Bacterio.

INTRODUCTION: Since 1997, the microbiology laboratory of the hospital center in Lens has monitored hospital ecology and epidemiology to provide rapid information that help to adapt probabilistic antibiotherapy and to estimate the impact of hygienic preventive measures on the incidence of multidrug-resistant bacteria (MRB). METHODS: Monitoring with statistical software (Epi-Info) could be pursued and improved on with Bacterio, a specific software for microbiology laboratories. We studied the incidence of MRB not only in clinical specimens but also in ecologic specimens to detect BMR colonization. RESULTS: In the year 2000, the incidence reached 4.11 for 1000 hospitalization days and 3.34 for 100 admissions. This clearly differed from clinical activity. From 1998 to 2000 the incidence of BMR remained stable. BMR was detected within 48 hours after admission in 22.9% of cases. Methicillin-resistant Staphylococcus aureus and ticarcillin-resistant Pseudomonas aeruginosa were the most common BMR in our hospital. Extended broad spectrum beta-lactamase enterobacterii and Acinetobacter baumannii represented respectively 23% and 13% of the MRB. Stenotrophomonas maltophilia represented a minority and no vancomycin-resistant enterococci were found. CONCLUSION: Bacterio is a software well adapted to the use of microbiological data banks. Continuous monitoring of the incidence of BMR is very useful in the clinical care and hospital hygiene units.