Epidemiology and Appropriateness of Antibiotic Prescribing in Severe Pneumonia After Lung Resection
| Autor: | Anne Casetta, Yên-Lan Nguyen, Samir Bouam, Rémy Gauzit, Aurélie Lefebvre, Antoine Rabbat, Julien Caliez, Kim Blanc, E. Canouï, Jean-François Regnard, Solen Kernéis, Marco Alifano, J. Loubinoux |
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| Přispěvatelé: | Université Paris Descartes - Paris 5 (UPD5), Biostatistique, Biomathématique, Pharmacoépidémiologie et Maladies Infectieuses (B2PHI), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM) |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
[SDV]Life Sciences [q-bio] 030204 cardiovascular system & hematology Antimicrobial Stewardship Postoperative Complications 0302 clinical medicine MESH: Aged 80 and over MESH: Postoperative Complications Epidemiology Antimicrobial stewardship Pneumonectomy Aged 80 and over MESH: Aged MESH: Middle Aged Incidence (epidemiology) Mortality rate Middle Aged Anti-Bacterial Agents 3. Good health Female Cardiology and Cardiovascular Medicine Empiric therapy Adult Pulmonary and Respiratory Medicine medicine.medical_specialty MESH: Pneumonia Bacterial 03 medical and health sciences Internal medicine MESH: Anti-Bacterial Agents Drug Resistance Bacterial MESH: Drug Resistance Bacterial Pneumonia Bacterial medicine Humans MESH: Antimicrobial Stewardship Aged Retrospective Studies MESH: Humans Bacteria business.industry MESH: Pneumonectomy Retrospective cohort study MESH: Adult MESH: Retrospective Studies Guideline medicine.disease MESH: Male Pneumonia MESH: Bacteria 030228 respiratory system Surgery business MESH: Female |
| Zdroj: | Annals of Thoracic Surgery Annals of Thoracic Surgery, Elsevier, 2019, 108 (1), pp.196-202. ⟨10.1016/j.athoracsur.2019.01.072⟩ Annals of Thoracic Surgery, 2019, 108 (1), pp.196-202. ⟨10.1016/j.athoracsur.2019.01.072⟩ |
| ISSN: | 0003-4975 1552-6259 |
| DOI: | 10.1016/j.athoracsur.2019.01.072⟩ |
| Popis: | International audience; Background: Postoperative pneumonia (POP) is a severe complication of major lung resection. The objective of this study was to describe the current epidemiology and appropriateness of antibiotic prescriptions in severe POP, 4 years after implementation of an antimicrobial stewardship program that was based on weekly multidisciplinary review of all antibiotic therapies.Methods: This study was a retrospective analysis of a prospectively collected database. It included all cases of severe POP occurring within 30 days after major lung resection of in a 1,500-bed hospital between 2013 and 2015. Criteria for severe POP were acute respiratory failure, severe sepsis, or a rapidly extensive pulmonary infiltrate. The study collected data on incidence, clinical outcomes, and microbiological analyses. Appropriateness of antibiotic prescribing was assessed by quality indicators previously validated in the literature.Results: Over the study period, 1,555 patients underwent major lung surgery. Severe POP occurred in 91 patients (5.8%; confidence interval, 4.7%; 7.0%), with a mortality rate of 9.0% (8 of 91; confidence interval, 3.0%; 14.6%). In POP with positive microbiological results, the proportion of gram-negative bacteria other than Haemophilus was 76% (50 of 66 cases). All patients (91 of 91) had respiratory samples taken within 24 hours after the start of antibiotics; empiric therapy was concordant with the guideline in 80% (69 of 86), and it was switched to pathogen-directed therapy in 74% (46 of 62). In 71 of 91 patients (78%), the antibiotic duration was up to 7 days.Conclusions: This study reported a high proportion of gram-negative bacteria in severe POP. Four years after implementation of the program, quality indicators of antibiotic prescribing were all >70%. The rate of de-escalation to pathogen-directed therapy could be improved, however. |
| Databáze: | OpenAIRE |
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