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

Link to article at PubMed

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

Med Mal Infect. 2011 Sep;41(9):480-5

Authors: Bornard L, Dellamonica J, Hyvernat H, Girard-Pipau F, Molinari N, Sotto A, Roger PM, Bernardin G, Pulcini C

Abstract
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.

PMID: 21778026 [PubMed - indexed for MEDLINE]

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