Pierre-Marie Roger1,2,3, Eve Montera4, Diane Lesselingue5, Nathalie Troadec6, Patrick Charlot7, Agnès Simand8, Agnès Rancezot9, Olivier Pantaloni10, Thomas Guichard11, Véronique Dautezac12, Cécile Landais13, Frédéric Assi3,14, Thierry Levent15. 1. Elsan Group, Rue de la Boétie, Paris. 2. Faculty of Medicine, University of Nice Sophia-Antipolis, France. 3. Réso-Infectio-PACA-Est, Toulon and Nice, France. 4. Pharmacy, St Roch Clinic, Cabestany. 5. Pharmacy, Jeanne d'Arc Clinic, Arles. 6. Pharmacy, St Augustin Clinic, Bordeaux. 7. Anesthesia-Intensive Care Unit, Inkermann Clinic, Niort. 8. Pharmacy-Hygiene, Santé République Medical Centre, Clermont Ferrand. 9. Cardiology, Medical and Cardiology Clinic, Aressy. 10. Pharmacy, St Pierre Clinic, Perpignan. 11. Pharmacy, Jean Villar Clinic, Bordeaux. 12. Pharmacy, Sidobre Clinic, Castres. 13. Internal Medicine and Infectology, Hôpital Privé Océane, Vannes. 14. Les Fleurs Clinic, Ollioules. 15. Vauban Clinic, Valenciennes, France.
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.
BACKGROUND: Assessment of antimicrobial use places an emphasis on therapeutic aspects of infectedpatients. 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.
Authors: Luisa Salazar-Vizcaya; Andrew Atkinson; Andreas Kronenberg; Catherine Plüss-Suard; Roger D Kouyos; Viacheslav Kachalov; Nicolas Troillet; Jonas Marschall; Rami Sommerstein Journal: BMC Infect Dis Date: 2022-05-23 Impact factor: 3.667
Authors: Jan Kristian Damås; Lars Heggelund; Bjørn Waagsbø; Eva Margrethe Buset; Jørn-Åge Longva; Merete Bjerke; Birgitte Bakkene; Anne-Stine Ertesvåg; Hanne Holmen; Marko Nikodojevic; To Thy Tran; Andreas Christensen; Einar Nilsen Journal: BMC Infect Dis Date: 2022-03-02 Impact factor: 3.090