Implementation of a simple innovative system for postprescription antibiotic review based on computerized tools with shared access.

Autor: Bouchand F; Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France. Electronic address: frederique.bouchand@aphp.fr., Dinh A; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Roux AL; Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Davido B; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Michelon H; Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Lepainteur M; Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Legendre B; Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., El Sayed F; Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Pierre I; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Salomon J; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Lawrence C; Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Perronne C; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Villart M; Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France., Crémieux AC; Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2017 Mar; Vol. 95 (3), pp. 312-317. Date of Electronic Publication: 2016 Nov 26.
DOI: 10.1016/j.jhin.2016.11.011
Abstrakt: Background: Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance.
Aim: To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital.
Methods: An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum β-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions. The data [patient, antibiotic(s), prescription start date, etc.] were registered on an AMT spreadsheet with shared access, where the microbiologist's opinion on the drug choice, based on available microbiology results, was entered. When the microbiologist and pharmacist did not approve the antibiotic prescribed, a same-day alert was generated and sent to the IDS. That alert led the IDS to re-evaluate the treatment.
Findings: From 2012 to 2014, 2106 targeted antibiotic prescriptions were reviewed. Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the IDS. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was <30 min/day for each AMT member. This system allowed correct use of targeted antibiotics for 91.8% of prescriptions, but had no significant impact on targeted antibiotic consumption.
Conclusion: This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limited misuse of broad-spectrum antibiotics.
(Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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