Impact of an assisted reassessment of antibiotic therapies on the quality of prescriptions in an intensive care unit

作者：Bornard L; Dellamonica J; Hyvernat H; Girard Pipau F; Molinari N; Sotto A; Roger P M; Bernardin G; Pulcini C^*

来源：Medecine et Maladies Infectieuses, 2011, 41(9): 480-485.

DOI：10.1016/j.medmal.2010.12.022

• Antibiotic therapy
• Intensive care unit
• Antibiotic stewardship

Objectives. - The study's objective was to assess the impact of a professional multifaceted intervention designed to improve the quality of inpatient empirical therapeutic antibiotic courses at the time of their reassessment, i.e. 24 to 96 hours after treatment initiation.
Design. - We conducted a 5-month prospective pre- and post-intervention study in a medical Intensive Care Unit (ICU) in a teaching hospital, using time-series analysis. The intervention was a multifaceted professional intervention combining systematic 3-weekly visits of an infectious diseases specialist to discuss all antibiotic therapies, interactive teaching courses, and daily contact with a microbiologist.
Results. - Eighty-one antibiotic prescriptions were assessed, 37 before and 44 after the intervention. The prevalence of adequate antibiotic prescriptions was high and not statistically different before and after the intervention (73% vs. 80%, P = 0.31), both for sudden change (P = 0.67) and linear trend (P = 0.055), using interrupted time-series analysis. The intervention triggered a more frequent reassessment of the diagnosis between day 2 and day 4 (11% vs. 32%, P = 0.02) and slightly improved the adaptation of antibiotic therapies to positive microbiology (25% before vs. 50% after, P = 0.18).
Conclusions. - Our multifaceted intervention may have improved the quality of antibiotic therapies around day 3 of prescription, but the difference did not reach statistical significance, possibly because of a ceiling effect.

• 出版日期2011-9