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Roger PM, Montera E, Lesselingue D, Troadec N, Charlot P, Simand A, Rancezot A, Pantaloni O, Guichard T, Dautezac V, Landais C, Assi F, Levent T. Risk Factors for Unnecessary Antibiotic Therapy: A Major Role for Clinical Management. Clin Infect Dis 2020; 69:466-472. [PMID: 30403779 DOI: 10.1093/cid/ciy921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Assessment of antimicrobial use places an emphasis on therapeutic aspects of infected patients. Our aim was to determine the risk factors for unnecessary antibiotic therapy (UAT). METHODS This was a prospective, multicenter study evaluating all curative antibiotic therapies prescribed over 2 consecutive days through the same electronic medical records. Each item that could participate in these prescriptions was collected from the computerized file (reason for hospitalization, comorbid conditions, suspected or definitive diagnosis of infection, microbial analyses). UAT was defined as the recognition of noninfectious sydromes (NIS), nonbacterial infections, use of redundant antimicrobials, and continuation of empirical broad-spectrum antimicrobials. RESULTS Four hundred fifty-three antibiotic therapies were analyzed at 17 institutions. An infectious disease was the reason for hospitalization in 201 cases (44%). An unspecified diagnosis of infection was observed in 104 cases (23%). Microbial samples were taken in 296 cases (65%), allowing isolation of a pathogen in 156 cases (53%). Unspecified diagnosis was associated with the absence of a microbial sample compared to patients with a diagnosis: (56/104 [54%] vs 240/349 [69%]; P = .005). A total of 158 NIS were observed (35%). UAT was observed in 169 cases (37%), due to NIS in 106 cases. In multivariate analysis, the modifiable risk factors for UAT were unspecified diagnosis (adjusted odds ratio [AOR], 1.83; 95% confidence interval [CI], 1.04-3.20) and absence of a blood culture (AOR, 5.26; 95% CI, 2.56-10.00). CONCLUSIONS UAT is associated with an unspecified diagnosis and the absence of microbial testing. Antimicrobial stewardship programs should focus on diagnostic difficulties and microbial testing, the latter facilitating antibiotic reassessment and therapeutic interruption.
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Affiliation(s)
- Pierre-Marie Roger
- Elsan Group, Rue de la Boétie, Paris.,Faculty of Medicine, University of Nice Sophia-Antipolis, France.,Réso-Infectio-PACA-Est, Toulon and Nice, France
| | | | | | | | | | - Agnès Simand
- Pharmacy-Hygiene, Santé République Medical Centre, Clermont Ferrand
| | | | | | | | | | - Cécile Landais
- Internal Medicine and Infectology, Hôpital Privé Océane, Vannes
| | - Frédéric Assi
- Réso-Infectio-PACA-Est, Toulon and Nice, France.,Les Fleurs Clinic, Ollioules
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Perozziello A, Lescure FX, Truel A, Routelous C, Vaillant L, Yazdanpanah Y, Lucet JC. Prescribers' experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey. J Antimicrob Chemother 2020; 74:2451-2458. [PMID: 31167027 DOI: 10.1093/jac/dkz179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To assess prescribers' experiences and opinions regarding antimicrobial stewardship programme (ASP) activities. METHODS A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France. RESULTS All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0-1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA's usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%). CONCLUSIONS Prescribers perceived ASP mainly through its 'on-demand' counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
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Affiliation(s)
- A Perozziello
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - F X Lescure
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - A Truel
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - C Routelous
- Institut du Management/EA 7348 MOS Management des organisations en santé, Ecole des hautes études en santé publique, EHESP, Rennes, Sorbonne Paris Cité, Paris, France
| | - L Vaillant
- UHLIN, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Y Yazdanpanah
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - J C Lucet
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,UHLIN, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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3
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Stordeur F, Miliani K, Lacavé L, Rogues AM, Dumartin C, Alfandari S, Astagneau P, L'Hériteau F. How to measure hospital antibiotic consumption: comparison of two methods from data surveillance in France. JAC Antimicrob Resist 2020; 2:dlaa059. [PMID: 34223016 PMCID: PMC8210307 DOI: 10.1093/jacamr/dlaa059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. Objectives To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. Methods The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman’s correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. Results A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. Conclusions Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement.
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Affiliation(s)
- Florence Stordeur
- Centre hospitalier intercommunal de Poissy St Germain, 10 rue du champ Gaillard, 78100 Poissy, France
| | - Katiuska Miliani
- Centre d'appui pour la prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France
| | - Ludivine Lacavé
- Assistance Publique - Hôpitaux de Paris (AP-HP), délégation à la recherche clinique et à l'innovation (DRCI), Paris, France
| | - Anne-Marie Rogues
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,CHU Bordeaux, Hygiène hospitalière, F-33000 Bordeaux, France
| | - Catherine Dumartin
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,CHU Bordeaux, CPias Nouvelle Aquitaine, F-33000 Bordeaux, France
| | | | - Pascal Astagneau
- Centre d'appui pour la prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - François L'Hériteau
- Centre d'appui pour la prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France
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Aillet C, Jammes D, Fribourg A, Léotard S, Pellat O, Etienne P, Néri D, Lameche D, Pantaloni O, Tournoud S, Roger PM. Bacteraemia in emergency departments: effective antibiotic reassessment is associated with a better outcome. Eur J Clin Microbiol Infect Dis 2017; 37:325-331. [DOI: 10.1007/s10096-017-3136-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022]
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5
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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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6
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Nitsch-Osuch A, Okruciński D, Dawgiałło M, Gołębiak I, Kuchar E. Evaluation of the Implementation of Hospital Antibiotic Policy in Oncosurgery Ward: A Six-Year Experience. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1047:21-30. [DOI: 10.1007/5584_2017_122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7
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Risk of surgical site infection in older patients in a cohort survey: targets for quality improvement in antibiotic prophylaxis. Int Surg 2016; 100:473-9. [PMID: 25785330 DOI: 10.9738/intsurg-d-14-00042.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aims of the present study were to: (1) assess surgical site infection (SSI) incidence in a cohort of surgical patients and (2) estimate the compliance with national guidelines for perioperative antibiotic prophylaxis (PAP). SSIs, among the most common health care-associated infections, are an important target for surveillance and an official priority in several European countries. SSI commonly complicates surgical procedures in older people and is associated with substantial attributable mortality and costs. The implementation of PAP guidelines is difficult among surgeons, and failure to comply with the standard of care has been widely reported. A 12-month prospective survey was performed in accordance with the methods, protocols, and definitions of the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol. The compliance of the current PAP practices with the published national guidelines was assessed. A total of 249 patients were enrolled. The cumulative SSI incidence was 3.2 per 100 operative procedures. Cumulative compliance for PAP was 12.4%. Overall, only infection risk index ≥ 1 was confirmed as a significant risk factor for SSI (odds ratio, 6.65; 95% confidence interval, 1.04-42.59; P = 0.045). When only older patients (age >65 years) were considered, no significant risk factors for SSI were identified. Our study indicates an overall inadequate compliance with PAP recommendations, thus highlighting the need to develop multimodal and targeted intervention programs to improve compliance with PAP guidelines.
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8
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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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9
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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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Couderc C, Lacavé L, L'Hériteau F, Astagneau P. Surveillance of Overall Hospital Antibiotic Consumption: Is Stratification according to Hospital Size the Best Method? Infect Control Hosp Epidemiol 2015; 32:1223-5. [DOI: 10.1086/662622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Birgand G, Miliani K, Carbonne A, Astagneau P. Is High Consumption of Antibiotics Associated with Clostridium difficile Polymerase Chain Reaction–Ribotype 027 Infections in France? Infect Control Hosp Epidemiol 2015; 31:302-5. [DOI: 10.1086/650758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We compared antibiotic consumption between hospitals affected by a strain of Clostridium difficile designated as polymerase chain reaction–ribotype 027 (CD-027) and those unaffected during an outbreak in northern France. The mean consumption of several β-lactams, amikacin, and fluoroquinolones was high in affected hospitals (P<.05). However, only levofloxacin and imipenem remained associated with emerging CD-027 in the multivariate analysis, suggesting that those antibiotics should be better targeted by prevention campaigns.
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12
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Zahar JR, Lesprit P. Management of multidrug resistant bacterial endemic. Med Mal Infect 2014; 44:405-11. [PMID: 25169940 DOI: 10.1016/j.medmal.2014.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
The fight against multi-drug resistant Gram-negative bacilli (MDRGNB), especially extended-spectrum β-lactamase producing Enterobacteriaceae, is about to be lost in our country. The emergence of new resistance mechanisms to carbapenems in these Enterobacteriaceae exposes patients to a risk of treatment failure without any other therapeutic options. This dramatic situation is paradoxical because we are well aware of the 2 major factors responsible for this situation: 1) MDRO cross-transmission, associated with a low compliance to standard precautions, especially hand hygiene, and 2) overexposure of patients to antibiotics. The implementation of a "search and isolate" policy, which was justified to control the spread of some MDRO that remained rare in the country, was not associated with a better adherence to standard precautions. The antibiotic policy and the measures implemented to control antibiotic consumptions have rarely been enforced and have shown inconsistent results. Notably, no significant decrease of antibiotic consumption has been observed. There is no excuse for these poor results, because some authors evaluating the effectiveness of programs for the control of MDRO have reported their positive effects on antimicrobial resistance without any detrimental effects. It is now urgent to deal with the 2 major factors by establishing an educational and persuasive program with quantified and opposable objectives. Firstly, we have to improve the observance of hand hygiene above 70%. Secondly, we have to define and reach a target for the reduction of antibiotic consumption both in community and in hospital settings.
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Affiliation(s)
- J-R Zahar
- Unité de prévention et de lutte contre les infections nosocomiales, université d'Angers, centre hospitalo-universitaire d'Angers, 4, rue Larrey, 49000 Angers, France.
| | - P Lesprit
- Infectiologie transversale, laboratoire de biologie, hôpital Foch, 92151 Suresnes, France
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Marquet A, Ollivier F, Boutoille D, Thibaut S, Potel G, Ballereau F. A national network of infectious diseases experts. Med Mal Infect 2013; 43:475-80. [PMID: 24262913 DOI: 10.1016/j.medmal.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/24/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to consider the implementation of a network of infectious diseases (ID) experts to optimize the antibiotic prescriptions of community and hospital practitioners. METHODS An observational prospective study was conducted among ID experts in the Pays-de-la-Loire Region to evaluate the number of calls and to determine the practitioner's reasons for soliciting ID expertise. For each phone consultation, four criteria were recorded during 5 days: origin of the call (internal/external), kind of question (diagnostic/therapeutic) time spent for the advice provided, type of advice. RESULTS A total of 386 phone consultations for 20 infectious disease specialists were recorded during the study period (5 days); 81% were internal to the hospital, 7.7% from another hospital, and 11.3% from private practice, 56.3% of the questions concerned a therapeutic strategy, 21% a diagnostic advice, and 22.6% concerned both diagnosis and therapy. Two third of the questions were answered within 10minutes. In 68.7% of cases, the ID specialist answered immediately, 19.8% of calls required following-up the patient, 6% led to refer the patient to an ID consultation, and 5.5% to hospitalization. CONCLUSION The survey results stress the important need for such ID expertise, both in hospitals and in ambulatory medicine. Collaboration of ID specialists in a regional network would allow an easy and permanent access to antibiotic therapy advice for prescribers. This network would improve the quality and safety of care.
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Affiliation(s)
- A Marquet
- Centre MedQual, hôpital St-Jacques, CHU de Nantes, 85, rue St-Jacques, 44093 Nantes, France.
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Roger PM, Labate C, Serre S, Zumbo C, Valério L, Bonnet H, Jurado A, Bélé N, Brofferio P. Factors associated with effective reassessment of antibiotic therapy on day 3. Med Mal Infect 2013; 43:123-7. [DOI: 10.1016/j.medmal.2012.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/23/2012] [Accepted: 12/07/2012] [Indexed: 11/28/2022]
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15
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Mondain V, Lieutier F, Dumas S, Gaudart A, Fosse T, Roger PM, Bernard E, Farhad R, Pulcini C. An antibiotic stewardship program in a French teaching hospital. Med Mal Infect 2013; 43:17-21. [DOI: 10.1016/j.medmal.2012.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 09/24/2012] [Accepted: 10/31/2012] [Indexed: 12/01/2022]
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Doshi N, Damant G, Shatwell J, Amelan R, Taylor M, Maxwell S, Catania J. Antibiotic stewardship: sharing experience from a teaching hospital in united kingdom. drugs, bugs, bucks and brains... Pathology 2012. [DOI: 10.1016/s0031-3025(16)32803-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Barchitta M, Matranga D, Quattrocchi A, Bellocchi P, Ruffino M, Basile G, Agodi A. Prevalence of surgical site infections before and after the implementation of a multimodal infection control programme. J Antimicrob Chemother 2011; 67:749-55. [PMID: 22127586 DOI: 10.1093/jac/dkr505] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES In order to assess the prevalence of surgical site infections (SSIs) before and after the implementation of a multimodal infection control programme including the realization of a campaign to increase compliance with guidelines for antimicrobial prophylaxis, we designed and conducted the present study involving all 20 of the surgical departments of a large teaching hospital in Catania, Italy. PATIENTS AND METHODS SSI definitions of the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol were used in four 1 day point-prevalence surveys. After the first survey, an infection control programme was implemented involving the active commitment of surgeons and infection control staff. RESULTS Overall, a total of 600 surgical patients were enrolled. A significant decreasing trend in the SSI rate (from 16.4 to 8.2 per 100 surgical patients, P=0.018) was shown. After multivariate analysis, significant risk factors for SSI were identified: age >31 years, kidney insufficiency and infection at admission. Taking into account the indication and the timing of administration of antibiotic prophylaxis, in the four surveys prophylaxis was administered inappropriately in 55.3% of surgical procedures. CONCLUSIONS The approach used in this study remains a feasible method of evaluating the burden of SSIs using repeated prevalence surveys. The results provide evidence of a significant decreasing trend in the SSI rate following the infection control intervention. Furthermore, our study underlines the need to develop evidence-based guidelines in collaboration with surgeons, to achieve consensus before implementation in order to improve compliance with antimicrobial prophylaxis and, finally, decrease SSI rates.
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18
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Antimicrobial stewardship program and quality of antibiotic prescriptions. Med Mal Infect 2011; 41:608-12. [DOI: 10.1016/j.medmal.2011.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 05/07/2011] [Accepted: 07/22/2011] [Indexed: 11/23/2022]
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Bevilacqua S, Demoré B, Boschetti E, Doco-Lecompte T, May I, May T, Rabaud C, Thilly N. 15 years of antibiotic stewardship policy in the Nancy Teaching Hospital. Med Mal Infect 2011; 41:532-9. [PMID: 21907511 DOI: 10.1016/j.medmal.2011.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/04/2011] [Accepted: 08/03/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The authors report the results of a 15-year antibiotic stewardship policy in the Nancy Teaching Hospital and assess the impact of reinforcing this policy on antibiotic consumption. METHODS Antibiotic stewardship policy was initiated in the mid 90s and then reinforced from 2006 onwards. It was completed by prescription guidelines, nominative prescription of antibiotics, and an operational infectious diseases team (OIDT). The objectives were to promote antibiotic stewardship and decrease the use of extended broad spectrum or costly molecules and intravenous administration. Antibiotics consumption, as defined daily dose per 1000 patient days (DDD/1000PD) and in euros, was monitored from 2005 onwards. RESULTS Between 2005 and 2008, overall yearly cost of antibiotics dropped by 34% (-€1,308,902) and consumption in DDD/1000PD by 10%. This drop in consumption concerned all antibiotic classes. Teicoplanin prescription dropped by more than 50% and use of fluoroquinolone IV decreased by 15% in 3years. The operational team's interventions were effective since nearly 80% of suggested prescription amendments were accepted by prescribers. CONCLUSIONS This experiment shows that it is possible to implement antibiotic stewardship policy. Our results prove a significant decrease in overall consumption of antibiotic, a change in prescribing patterns, with a shift towards the use of cheaper antibiotics.
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Affiliation(s)
- S Bevilacqua
- Service des maladies infectieuses et tropicales, CHU Nancy, hôpitaux de Brabois, bâtiment P. Canton, rue du Morvan, Vandœuvre-Lès-Nancy, Nancy, France.
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Pulcini C, Dellamonica J, Bernardin G, Molinari N, Sotto A. Impact of an intervention designed to improve the documentation of the reassessment of antibiotic therapies in an intensive care unit. Med Mal Infect 2011; 41:546-52. [PMID: 21855239 DOI: 10.1016/j.medmal.2011.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/19/2011] [Accepted: 07/06/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The study objectives were: (i) to design an intervention to improve the written documentation of empiric antibiotic prescriptions' reassessment; (ii) and to assess the impact of this intervention on the quality of prescriptions. PATIENTS AND METHODS A prospective before and after 7-month intervention study in a medical ICU in a French teaching hospital, using interrupted time-series analysis. The intervention was made to improve the documentation of four process measures in medical records: antibiotic plan, reviewing the diagnosis, adapting to positive microbiological results, and IV-per os switch. RESULTS One hundred and fourteen antibiotic prescriptions were assessed, 62 before and 52 after the intervention. The reassessment of antibiotic prescriptions was more often documented in the ICU after the intervention (P=0.03 for sudden change). The prevalence of appropriate antibiotic prescriptions was not statistically different before and after the intervention, either for sudden change and/or linear trend. CONCLUSION A better documentation of antibiotic prescriptions' reassessment was achieved in this ICU, but it did not improve the quality of antibiotic prescriptions.
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Affiliation(s)
- C Pulcini
- Service d'infectiologie, hôpital l'Archet-1, centre hospitalier universitaire de Nice, 151 route Saint-Antoine-de-Ginestière, Nice cedex 3, France.
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Dumartin C, Rogues AM, Amadéo B, Péfau M, Venier AG, Parneix P, Maurain C. Antibiotic usage in south-western French hospitals: trends and association with antibiotic stewardship measures. J Antimicrob Chemother 2011; 66:1631-7. [DOI: 10.1093/jac/dkr179] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Miliani K, L’Hériteau F, Lacavé L, Carbonne A, Astagneau P. Imipenem and ciprofloxacin consumption as factors associated with high incidence rates of resistant Pseudomonas aeruginosa in hospitals in northern France. J Hosp Infect 2011; 77:343-7. [DOI: 10.1016/j.jhin.2010.11.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
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Amadeo B, Dumartin C, Parneix P, Fourrier-Réglat A, Rogues AM. Relationship between antibiotic consumption and antibiotic policy: an adjusted analysis in the French healthcare system. J Antimicrob Chemother 2010; 66:434-42. [PMID: 21148234 DOI: 10.1093/jac/dkq456] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In France, the public reporting of antibiotic policies in hospitals has been mandatory since 2007. Consequently, all hospitals provide to the Ministry of Health an annual follow-up of antibiotic policy. This study aimed at identifying antibiotic policy measures related to a lower antibiotic consumption. METHODS Data on antibiotic policy were extracted from the 2007 infection control indicator database in 977 acute hospitals providing antibiotic consumption data expressed in defined daily doses per 1000 patient-days (84% of all acute French hospitals). Policy data were collected using a standardized questionnaire including nine measures. From these measures, a composite score of 20 points and three policy sub-scores (organization, resource and action) were defined. Logistic regression analyses were performed using antibiotic consumption as dependent variables. Antibiotic consumption was categorized as low (≤ 75th percentile) or high (>75th percentile). All models were adjusted for hospital characteristics. RESULTS Hospitals had an average score of 13.8 out of 20 points.The least common antibiotic policy measures were information technology support such as a computerized link between pharmacy, laboratory and wards (39%) and information technology support for prescription (33%). Multivariable analysis showed that a high resource score was significantly associated with lower antibiotic consumption. Among measures included in the resource score, information technology support for prescription was significantly associated with lower antibiotic consumption. The odds ratio was 0.55 (95% confidence interval 0.39-0.78). CONCLUSIONS Information technology support for prescription could play an important role in controlling antibiotic consumption. Further investigations should study the type of computerized prescription system to implement in hospitals.
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Dumartin C, Rogues AM, Amadeo B, Pefau M, Venier AG, Parneix P, Maurain C. Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005-2008. J Hosp Infect 2010; 77:123-8. [PMID: 20884081 DOI: 10.1016/j.jhin.2010.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/17/2010] [Indexed: 10/19/2022]
Abstract
French hospitals are required to implement antibiotic stewardship programmes (ABS) to improve antibiotic use. We analysed the legal framework on ABS and assessed its impact on hospitals' ABS development in Southwestern France. For each official text, required measures, date of issue, means of control and incentives were analysed. Annual retrospective surveys were conducted in 84 hospitals from 2005 to 2008 to monitor implementation of ABS components: organisation, resources and actions. Evolution of individual measures and of a structure and process indicator (SPI) reflecting ABS was described for each hospital. From 2002, official texts issued by health authorities set out requirements on ABS, based on previous professional guidelines. Incentives and means of control were reinforced in 2006 and in 2007 with mandatory reporting of SPI for public disclosure. ABS implementation improved during the course of the study period. In 2008, at least 98% of hospitals had implemented formularies, antibiotic committees, surgical prophylaxis guidelines, and monitored antibiotic use; antibiotic advisors were appointed in 85% of hospitals. Little progress was made regarding time dedicated by pharmacists to antibiotic management and restrictive dispensation using stop-orders. Computerised tools, continuing education and audits remained under-used. SPI values were higher in private hospitals and rehabilitation centres than in others. Official texts and the SPI public disclosure increased professionals' and hospital managers' commitment to develop ABS, resulting in improvements. However, some actions still need to be reinforced. It appears crucial to monitor practical implementation to better approach ABS effectiveness and to adapt requirements.
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Affiliation(s)
- C Dumartin
- Southwestern Regional Coordinating Centre for Nosocomial Infection Control (CCLIN), Bordeaux, France.
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Cooke J, Alexander K, Charani E, Hand K, Hills T, Howard P, Jamieson C, Lawson W, Richardson J, Wade P. Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother 2010; 65:2669-73. [DOI: 10.1093/jac/dkq367] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dumartin C, L'Heriteau F, Pefau M, Bertrand X, Jarno P, Boussat S, Angora P, Lacave L, Saby K, Savey A, Nguyen F, Carbonne A, Rogues AM. Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007. J Antimicrob Chemother 2010; 65:2028-36. [DOI: 10.1093/jac/dkq228] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Malta R, Di Rosa S, D’Alessandro N. Aspetti etici e controllo di gestione dei farmaci antibiotici antibatterici. ITALIAN JOURNAL OF MEDICINE 2010. [DOI: 10.1016/j.itjm.2010.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Amadeo B, Dumartin C, Robinson P, Venier A, Parneix P, Gachie J, Fourrier-Réglat A, Rogues A. Easily available adjustment criteria for the comparison of antibiotic consumption in a hospital setting: experience in France. Clin Microbiol Infect 2010; 16:735-41. [DOI: 10.1111/j.1469-0691.2009.02920.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bertino JS. Impact of antibiotic resistance in the management of ocular infections: the role of current and future antibiotics. Clin Ophthalmol 2009; 3:507-21. [PMID: 19789660 PMCID: PMC2754082 DOI: 10.2147/opth.s5778] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Indexed: 12/03/2022] Open
Abstract
Purpose: This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections. Design: Interpretive assessment. Methods: Literature review and interpretation. Results: Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be developed and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the development of resistance are needed. Conclusions: New antimicrobial agents that treat ocular infections effectively and have a low potential for the development of resistance could be a part of strategies to prevent the global increase in ocular pathogen resistance.
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Affiliation(s)
- Joseph S Bertino
- College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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