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Michelangeli C, Courjon J, Curlier E, Roger PM. Cotrimoxazole for community-acquired urinary tract infections leads to more adverse effects than fluoroquinolones. Infect Dis Now 2021; 51:374-376. [PMID: 33975674 DOI: 10.1016/j.idnow.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/20/2020] [Accepted: 11/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND For several years, we applied an internal guideline for community-acquired urinary tract infections (cUTI), targeting the reduction of fluoroquinolone use (FQ) and thereby favouring cotrimoxazole (CTM) prescription. Our aim was to report adverse effects (AE) and outcome for patients presenting with cUTI and treated with these compounds. METHODS This cohort study was based on the dashboard of our department, bringing together 28 parameters for all patients, including diagnosis, microbiological data, antibiotic therapy, AE, length of hospital stay (LHS) and outcome. We included all patients with cUTI due to Enterobacteriaeae treated with CTM or FQ, and compared these 2 groups on in-hospital AE, LHS, and unfavourable outcome defined as intensive care requirement or death. RESULTS From June 2008 to June 2019, 640 cUTI due to Enterobacteriaeae were observed, among which 295 (46%) treated with CTM and 345 (54%) with a FQ. There were 25 AE (3.9%): 17 (5.7%) in the CTM group, and 8 (2.3%) in the FQ group (P=0.025). Adverse effects were associated with increased LHS compared to patients without AE: 11±6 vs. 7±4 days respectively, P<0.001, 11.4±6.2 days in the CTM group vs. 9.2±5.8 in the FQ group (relative LHS increase of 73.5% and 29.5%, respectively). Unfavorable outcome occurred for 1 patient (0.3%) in the CTM group, and 5 (1.4%) in the FQ group, P=0.297. CONCLUSION Favouring cotrimoxazole for cUTI due to Enterobacteriaceae was associated compared to FQ with more AE and prolonged LHS. A cost-effectiveness analysis to validate such therapeutic strategy is warranted.
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Affiliation(s)
- C Michelangeli
- Infectiologie, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route Saint-Antoine-de-Ginestière 06200 Nice, France
| | - J Courjon
- Infectiologie, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route Saint-Antoine-de-Ginestière 06200 Nice, France; Faculté de médecine, université de Côte d'Azur, 28, avenue de Valombrose, 06100 Nice, France
| | - E Curlier
- Infectiologie, centre hospitalier universitaire, route de Chauvel, 97139 Les Abymes, Guadeloupe, France
| | - P-M Roger
- Infectiologie, centre hospitalier universitaire, route de Chauvel, 97139 Les Abymes, Guadeloupe, France; Faculté de médecine, université des Antilles, Fouillole, 97110 Pointe-à-Pitre, Guadeloupe, France.
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2
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Roger PM, Peyraud I, Vitris M, Romain V, Bestman L, Blondel L, Gras H, Hauchart C, Morandi V, Rancezot A, Borredon G, Dautezac V. Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study. J Antimicrob Chemother 2020; 75:747-755. [PMID: 31851314 DOI: 10.1093/jac/dkz490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. METHODS Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. RESULTS We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82-5.92 and 2.18, 95% CI 1.38-3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06-0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34-0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was -16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). CONCLUSIONS STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Clinique Les Fleurs, 332 ave Frédéric Mistral, 83110 Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Ingrid Peyraud
- Pharmacie, Clinique Inkermann, 84 Rte d'Aiffres, 79000 Niort, France
| | - Michel Vitris
- Hygiène, Clinique du Pont de Chaume, 330 ave Marcel Unal, 82000, Montauban, France
| | - Valérie Romain
- Anesthésie-Réanimation et Hygiène, Pôle Santé Atlantique, Ave Claude Bernard, 44819 St Herblain, France
| | - Laura Bestman
- Service Qualité, Clinique St Louis, 1 rue Basset, 78300 Poissy, France
| | - Lionel Blondel
- Hygiène, Clinique l'Orangerie, 29 allée de la Robertsau, 67000 Strasbourg, France
| | - Hélène Gras
- Pharmacie, Clinique Les Lauriers, 147 rue Jean Giono, 83600 Fréjus, France
| | - Christine Hauchart
- Pharmacie, Clinique St Claude, 1, Bd du Dr Schweitzer, 02100 Saint Quentin, France
| | - Véronique Morandi
- Pharmacie et Hygiène, Clinique St Roch, rue Ambroise Croizat, 66330 Cabestany, France
| | - Agnès Rancezot
- Pharmacie, Clinique Médicale et Cardiologique d'Aressy, rue de Lourdes, 64320 Aressy, France
| | - Gaelle Borredon
- Pharmacie, Clinique Ormeau, 12 chemin de l'Ormeau, 65000 Tarbes, France
| | - Véronique Dautezac
- Pharmacie, Clinique du Sidobre, chemin de St Hyppolyte, 81100 Castres, France
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3
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Hijazi K, Joshi C, Gould IM. Challenges and opportunities for antimicrobial stewardship in resource-rich and resource-limited countries. Expert Rev Anti Infect Ther 2019; 17:621-634. [PMID: 31282277 DOI: 10.1080/14787210.2019.1640602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Inappropriate prescription practices, patient and provider knowledge and attitudes, variable availability of diagnostic and surveillance systems, and the unrestricted use of antimicrobials in animals and plants are contributory factors to the global crisis of antimicrobial resistance (AMR). Areas covered: Notwithstanding that interventions to revert AMR should be tailored to the socio-politico-economic landscape, there is a global consensus for the implementation and enhancement of antimicrobial stewardship strategies. Yet the implementation of Antimicrobial Stewardship Programs (ASPs) remains relatively limited within healthcare settings and faces complex challenges in resource-limited countries. The current review summarizes the limitations of current ASPs, translation challenges in resource-limited countries, and potential solutions. Expert opinion: Suboptimal ASP implementation in hospitals is multifactorial. Restriction of antimicrobial use should be informed by risk-benefit analyses, including the potential for substitute prescribing, and displacement of selection pressures. Thresholds in population use of antibiotics above which AMR increases may provide quantitative targets for ASPs. Horizontal and vertical collaborations involving policymakers and the general public are of paramount importance. While impactful prescribing changes require sustained engagement of the public and health-care professionals, we warn against over-estimating the benefits of behavioral interventions. We advocate for population-level stewardship interventions in addition to investment in structural factors that will aid ASP implementation.
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Affiliation(s)
- Karolin Hijazi
- a Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen , Aberdeen , UK
| | - Chaitanya Joshi
- b Department of Medical Microbiology, Aberdeen Royal Infirmary , Aberdeen , UK
| | - Ian M Gould
- b Department of Medical Microbiology, Aberdeen Royal Infirmary , Aberdeen , UK
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Fernandez-Sierra MA, Rueda-Domingo MT, Rodriguez-del-Aguila MM, Perez-Lozano MJ, Force L, Fernandez-Villa T, Astray J, Egurrola M, Castilla J, Sanz F, Toledo D, Dominguez A. Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia. Epidemiol Infect 2018; 146:1870-1877. [PMID: 30070190 PMCID: PMC9506693 DOI: 10.1017/s0950268818002121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 11/06/2022] Open
Abstract
Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013-14 and 2014-15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1-53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15-1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25-2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1-56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03-7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.
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Affiliation(s)
- M. A. Fernandez-Sierra
- UGC Prevención Promoción y Vigilancia Salud. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. T. Rueda-Domingo
- UGC Prevención Promoción y Vigilancia Salud. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. M. Rodriguez-del-Aguila
- UGC Prevención Promoción y Vigilancia Salud. Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M. J. Perez-Lozano
- UGC Prevención, Promoción y Vigilancia Salud. Hospital de Valme, Sevilla, Spain
| | - L. Force
- Hospital de Mataró, Barcelona, Spain
| | - T. Fernandez-Villa
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS). Instituto de Biomedicina (IBIOMED). Universidad de León, León, Spain
| | - J. Astray
- Consejería de Sanidad de Madrid, Madrid, Spain
| | - M. Egurrola
- Hospital de Galdakao, Usansolo, Vizcaya, Spain
| | - J. Castilla
- Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - F. Sanz
- Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - D. Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - A. Dominguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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Mantero M, Tarsia P, Gramegna A, Henchi S, Vanoni N, Di Pasquale M. Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations. Multidiscip Respir Med 2017; 12:26. [PMID: 29034094 PMCID: PMC5628439 DOI: 10.1186/s40248-017-0106-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022] Open
Abstract
Community-acquired pneumonia is a common and serious disease, with high rates of morbidity and mortality. Management and treatment of community-acquired pneumonia are described in three main documents: the 2007 American Thoracic Society guidelines, the 2011 European Respiratory Society guidelines, and the 2009 British Thoracic Society guidelines, updated by the NICE in 2015. Despite the validity of current guidelines in improving prognosis and management of patients with community-acquired pneumonia, not all recommendations have high levels of evidence and there are still some controversial issues. In particular, there are some areas of low evidence such as the efficacy of an antibiotic molecule or scheme in patients with same risk factors; duration of antibiotic treatment, supportive therapy for acute respiratory failure and immunomodulation molecules. This review will summarize the main recommendations with high level of evidence and discuss the recommendations with lower evidence, analyzing the studies published after the guidelines’ release.
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Affiliation(s)
- Marco Mantero
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - Paolo Tarsia
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - Sonia Henchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - Nicolò Vanoni
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
| | - Marta Di Pasquale
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35 Milan, Italy
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6
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Roger PM, Demonchy E, Risso K, Courjon J, Leroux S, Leroux E, Cua É. Medical table: A major tool for antimicrobial stewardship policy. Med Mal Infect 2017; 47:311-318. [PMID: 28457702 DOI: 10.1016/j.medmal.2017.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/27/2016] [Accepted: 03/24/2017] [Indexed: 11/20/2022]
Abstract
Infectious diseases are unpredictable, with heterogeneous clinical presentations, diverse pathogens, and various susceptibility rates to anti-infective agents. These features lead to a wide variety of clinical practices, which in turn strongly limits their evaluation. We have been using a medical table since 2005 to monitor the medical activity in our department. The observation of heterogeneous therapeutic practices led to drafting up our own antibiotic guidelines and to implementing a continuous evaluation of their observance and impact on morbidity and mortality associated with infectious diseases, including adverse effects of antibiotics, duration of hospital stay, use of intensive care, and deaths. The 10-year analysis of medical practices using the medical table is based on more than 10,000 hospitalizations. It shows simplified antibiotic therapies and a reduction in infection-related morbidity and mortality. The medical table is a major tool for antimicrobial stewardship, leading to constant benefits for patients.
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Affiliation(s)
- P-M Roger
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France.
| | - E Demonchy
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France
| | - K Risso
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France
| | - J Courjon
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France
| | - S Leroux
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France
| | - E Leroux
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France
| | - É Cua
- Infectiologie, université de Nice Sophia-Antipolis, hôpital de l'Archet, centre hospitalier universitaire de Nice, 151, route de St-Antoine, 06202 Nice, France
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Mothes A, Léotard S, Nicolle I, Smets A, Chirio D, Rotomondo C, Tiger F, Del Giudice P, Perrin C, Néri D, Foucault C, Della Guardia M, Hyvernat H, Roger PM. Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy. Med Mal Infect 2016; 46:365-371. [DOI: 10.1016/j.medmal.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/28/2016] [Accepted: 05/13/2016] [Indexed: 11/30/2022]
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8
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Bacteraemic urinary tract infections may mimic respiratory infections: a nested case-control study. Eur J Clin Microbiol Infect Dis 2016; 35:1601-5. [PMID: 27272327 DOI: 10.1007/s10096-016-2697-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
Daily practice suggests that respiratory signs may be observed in bacteraemic urinary infections (BUI). Our objective was to search for an association between the presence of respiratory symptoms and the bacteraemic nature of urinary tract infections (UTI). A nested case-control study was carried out based on our computerised dashboard from January 2011 to June 2015. Cases were defined as patients with a BUI due to Enterobacteriaceae species, identified in blood and urine cultures. Controls had fever and a positive urinary sample but sterile blood cultures (NBUI) and a final diagnosis of urinary infection. Patients from the BUI group were 1:1 matched to the NBUI group according to four parameters: age, gender, cardiovascular and pulmonary comorbid conditions. Subjects with cognitive impairment limiting clinical accuracy and those with healthcare-associated infections were excluded. We compared systematically recorded respiratory and urinary symptoms between groups: signs on auscultation, dyspnoea, chest pain, cough and sputum, dysuria with burning, pollakiuria, flank or costovertebral angle tenderness and ischuria. One hundred BUI were compared to 100 NBUI, both groups exhibiting a similar rate for all considered comorbid conditions. In the BUI group, 58 % showed at least one respiratory sign vs. 20 % in the NBUI group, p < 0.001, while urinary signs were less frequent: 54 % vs. 71 %, p = 0.013. In the multivariate analysis, BUI was associated with the presence of abnormal pulmonary auscultation [adjusted odds ratio (AOR), 5.91; p < 0.001] and a trend towards less urinary symptoms (AOR, 1.58; p = 0.058). Patients with BUI presented with significantly more respiratory signs, which overshadowed urinary symptoms, compared to those with non-bacteraemic UTI. Such observations impact clinical decision-making.
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Recommandations du bon usage des antibiotiques : améliorer les pratiques médicales et non assujettir les infectiologues. Med Mal Infect 2016; 46:115-6. [DOI: 10.1016/j.medmal.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 11/23/2022]
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10
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Severe community-acquired pneumonia and positive urinary antigen test for S. pneumoniae: amoxicillin is associated with a favourable outcome. Eur J Clin Microbiol Infect Dis 2015; 34:2455-61. [DOI: 10.1007/s10096-015-2503-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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Prescriptions évitables de céphalosporines de troisième génération et de fluoroquinolones dans une structure d’urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2015. [DOI: 10.1007/s13341-015-0573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Roger PM, Courjon J, Léotard S, Déchamp C, Négrin N, Vassallo M. Antimicrobial stewardship policy: time to revisit the strategy? Eur J Clin Microbiol Infect Dis 2015; 34:2167-70. [PMID: 26387088 DOI: 10.1007/s10096-015-2483-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
Abstract
Recent data indicate that both the overall numbers of antibiotic prescription and the frequency of multidrug-resistant bacteria are increasing significantly. These threatening features are observed, despite national antimicrobial stewardship (AMS) policies aimed at decreasing antibiotic use. AMS should also focus on the initial steps leading to antibiotic prescription. Physicians and their patients should benefit from the structured clinical pathways, the latter being adapted to regional epidemiological data and resources. Continuous evaluation of these predefined clinical paths through a computerized medical dashboard will allow a critical review and finally the optimization of medical practices. These innovative behavioural approaches for clinicians will supply precise information on the relationship among the diagnosis, therapeutics and outcome. This changing environment will carry out the adapted therapeutic procedures, and appropriate antibiotic use will inherently improve.
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Affiliation(s)
- P-M Roger
- Infectiologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Hôpital de l'Archet 1, BP 3079, 06202, Nice, France.
| | - J Courjon
- Infectiologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Hôpital de l'Archet 1, BP 3079, 06202, Nice, France
| | - S Léotard
- Laboratoire de Bactériologie, Centre Hospitalier de Grasse, Grasse, France
| | - C Déchamp
- Pharmacie, Centre Hospitalier d'Antibes, Antibes, France
| | - N Négrin
- Service d'Hygiène Hospitalière, Centre Hospitalier de Grasse, Grasse, France
| | - M Vassallo
- Service de Médecine Interne et Infectiologie, Centre Hospitalier de Cannes, Cannes, France
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