Assessing the benefit of the 72-hour antibiotic therapy reassessment documentation

V Pérut; R Gauzit; S Kernéis; E Canouï; F X Chedhomme; R Batista; O Conort; S Bouam; J Raymond; J Loubinoux; A Chevallier; D Salmon-Ceron

doi:10.1016/j.medmal.2018.10.002

Assessing the benefit of the 72-hour antibiotic therapy reassessment documentation

Med Mal Infect. 2019 May;49(3):187-193. doi: 10.1016/j.medmal.2018.10.002. Epub 2018 Nov 9.

Authors

V Pérut¹, R Gauzit², S Kernéis³, E Canouï³, F X Chedhomme⁴, R Batista⁴, O Conort⁴, S Bouam⁵, J Raymond⁶, J Loubinoux⁶, A Chevallier⁴, D Salmon-Ceron⁷

Affiliations

¹ Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Service de santé publique, unité de gestion des risques et qualité, hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France. Electronic address: [email protected].
² Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Équipe mobile d'infectiologie, hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
³ Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Équipe mobile d'infectiologie, hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France.
⁴ Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Service de pharmacie des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
⁵ Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Unité d'information médicale, hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
⁶ Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Service de bactériologie, hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
⁷ Commission médicale des anti-infectieux (COMAI) des hôpitaux universitaires Paris centre, Assistance publique-Hôpitaux de Paris, 75014 Paris, France; Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de maladies infectieuses, hôpitaux universitaires Paris centre, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France.

PMID: 30420165
DOI: 10.1016/j.medmal.2018.10.002

Abstract

Objectives: To assess the documentation of the 72-hour antibiotic therapy reassessment in medical records.

Methods: One-day prevalence evaluation of curative antibiotic therapies≥72hours. The documentation of the reassessment was defined according to three criteria: (1) "clear" documentation (clinical or microbiological comment associated with a comment on the need to adjust the antibiotic therapy or on the lack of need); (2) "tacit" documentation (only based on a clinical or microbiological comment); (3) no documentation.

Results: We assessed 114 antibiotic therapies in 26 hospital departments. A clear reassessment at 72hours was observed in only 45 (39%) records and 31 (27%) records had no reassessment. The planned duration of treatment was written in 63 (55%) records. At 72hours, among the 71 antibiotic therapies with a microbiological documentation, 69 (97%) were active and 44 (62%) had a narrow spectrum. Among the 48 antibiotic therapies with a broad spectrum on day 1, only 21 (44%) benefited from a de-escalation at 72hours. A clearly recorded reassessment at 72hours was associated with de-escalation (P=0.025) and the prescription of a planned duration of treatment was associated with antibiotic therapy compliance with local or national guidelines (P=0.018).

Conclusion: Although reassessment was observed in 73% of records, it was correctly recorded at 72hours in only 39% of cases. The documentation of the reassessment and the prescription of a planned duration were associated with a better quality of antibiotic prescription (de-escalation, compliance with guidelines) and are relevant indicators for monitoring the proper use of antibiotics.

Keywords: Antibiothérapie; Antibiotic therapy; De-escalation; Désescalade; Reassessment; Réévaluation.

MeSH terms

Anti-Bacterial Agents / administration & dosage*
Anti-Bacterial Agents / adverse effects
Antimicrobial Stewardship / methods
Antimicrobial Stewardship / organization & administration
Antimicrobial Stewardship / standards
Cross-Sectional Studies
Documentation* / standards
Documentation* / statistics & numerical data
Drug Administration Schedule
Drug Monitoring / methods*
Drug Monitoring / standards
Drug Monitoring / statistics & numerical data
France / epidemiology
Hospitals / standards
Hospitals / statistics & numerical data
Humans
Medical Records* / standards
Medical Records* / statistics & numerical data
Prevalence
Program Evaluation
Risk Assessment
Time Factors

Substances

Anti-Bacterial Agents