Reassessment of antibiotic therapy in hospitals

Abstract

Introduction: French national guidelines state that antibiotic therapies should be reassessed between 48 and 72hours after treatment initiation and that reassessment of antibiotic therapy (RA) must be recorded in patients' files.

Objective: To determine whether RA is performed and recorded in patients' files in hospitals in a region of France.

Methods: Setting: hospitals participating in the National nosocomial infection point- prevalence survey (NPS) in Upper-Normandy, France. Patients included those receiving antibiotic therapy (excluding antibiotic prophylaxis) on NPS day, started in the hospital in which the survey was conducted and ongoing for more than 72hours. Data collected included characteristics of participating hospitals and, for each included patient, characteristics of ward, infection and antibiotic therapy, and mention in the patients' files of explicit or implicit RA. The rate of explicit and implicit RA was calculated and factors associated with explicit or implicit RA were evaluated using a univariate analysis.

Results: Thirty-three hospitals representing 87% of hospital beds region-wide were included in the study. In addition, 933 prescriptions were assessed for 724 infections in 676 patients. The overall rate of RA was 67.6% (49.3% of explicit RA and 18.3% of implicit RA). The rate of RA differed significantly according to infection and antibiotic class but not according to hospital or ward characteristics.

Conclusion: Our study provides new and reassuring results regarding reassessment of antibiotic therapy.

Keywords: Antibiothérapie empirique; Antibiotic reassessment; Antibiotic stewardship; Bon usage des antibiotiques; Empirical antibiotic therapy; Réévaluation de l’antibiothérapie.