Audit of antibiotic therapy used in 66 cases of endocarditis.
Med Mal Infect. 2011 Nov;41(11):602-7
Authors: Demonchy E, Dellamonica P, Roger PM, Bernard E, Cua E, Pulcini C
Abstract
OBJECTIVES: We wanted to assess the quality of antibiotic therapy prescribed for infective endocarditis in our ward.
DESIGN: We conducted a retrospective audit of all adult patients with endocarditis hospitalized over a 3-year period in the Infectious Diseases Unit of the Nice University Hospital, France. The quality of antibiotic therapy was assessed using the 2004 European Society of Cardiology guidelines as a reference. Antibiotic therapy was considered as appropriate only if the five following items complied with guidelines: antibiotic, dose, route, interval of administration, and duration of antibiotic treatment.
RESULTS: Sixty-six patients were included, 63years of age on average. Antibiotic therapy complied with guidelines in 14% of the cases. The most frequent causes of inappropriate therapy were: gentamicin prescribed as a single daily dose in 55% (27/49) of the cases, unnecessary prescriptions of rifampin in 72% (18/25) of the cases, and too long duration of gentamicin course for staphylococcal endocarditis in 32% (9/28) of the cases. Antibiotic therapy was switched from intravenous to oral route in 29% of the patients (n=19), 18±9 days after starting therapy on average. These endocarditis were mainly left-sided (n=12) and/or complicated (n=15). There was no significant association between mortality and inappropriate antibiotic therapy (14% if inappropriate vs. 22%, P=0.62) or between mortality and oral switch (0% if oral switch vs. 21%, P=0.052).
CONCLUSIONS: Infective endocarditis antibiotic treatment rarely complied with the 2004 European guidelines, but this did not have a negative impact on mortality. Switching antibiotic therapy from intravenous to oral route was common, even for complicated left-sided endocarditis, and was associated with a favorable outcome in all cases.
PMID: 21924571 [PubMed - indexed for MEDLINE]