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6 results on '"MESH : Drug Prescriptions"'

1. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals

Author

Ian M. Gould, Philip Howard, Céline Pulcini, Stéphan Juergen Harbarth, Robert West, G. Levy Hara, Dilip Nathwani, Leeds Teaching Hospitals NHS Trust, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hospital Carlos G. Durand, Leeds Institute for Health Sciences (LIHS), Faculty of Medicine and Health [Leeds], University of Leeds-University of Leeds, Aberdeen Royal Infirmary, Prévention et contrôle des infections (PCI ), Hôpitaux Universitaires de Genève (HUG), Ninewells Hospital and Medical School [Dundee], Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Leeds Institute for Health Sciences ( LIHS ), Prévention et contrôle des infections ( PCI ), and Hôpitaux Universitaires de Genève ( HUG )

Subjects
Cross-sectional study, MESH : Drug Prescriptions, MESH: Global Health, Global Health, MESH : Drug Utilization, antibiotic prescription, 0302 clinical medicine, MESH : Cross-Sectional Studies, MESH: Drug Prescriptions, Antimicrobial stewardship, Pharmacology (medical), 030212 general & internal medicine, MESH : Anti-Bacterial Agents, MESH: Drug Utilization, ddc:616, 0303 health sciences, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Antimicrobial, MESH: Hospitals, Hospitals, Organizational Policy, Antibiotic prescription, Anti-Bacterial Agents, 3. Good health, MESH : Hospitals, Infectious Diseases, Health Services Research, MESH : Organizational Policy, MESH: Health Services Research, Microbiology (medical), medicine.medical_specialty, MESH : Health Services Research, Drug Prescriptions, 03 medical and health sciences, Pharmacy (field), MESH: Cross-Sectional Studies, Environmental health, Electronic prescribing, MESH: Anti-Bacterial Agents, medicine, Humans, Intensive care medicine, Pharmacology, MESH: Humans, 030306 microbiology, business.industry, MESH : Humans, Drug Utilization, antibiotic policy, Cross-Sectional Studies, MESH : Global Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Organizational Policy, antibiotic management, business
Abstract

Objectives To report the extent and components of global efforts in antimicrobial stewardship (AMS) in hospitals. Methods An Internet-based survey comprising 43 questions was disseminated worldwide in 2012. Results Responses were received from 660 hospitals in 67 countries: Africa, 44; Asia, 50; Europe, 361; North America, 72; Oceania, 30; and South and Central America, 103. National AMS standards existed in 52% of countries, 4% were planning them and 58% had an AMS programme. The main barriers to implementing AMS programmes were perceived to be a lack of funding or personnel, a lack of information technology and prescriber opposition. In hospitals with an existing AMS programme, AMS rounds existed in 64%; 81% restricted antimicrobials (carbapenems, 74.3%; quinolones, 64%; and cephalosporins, 58%); and 85% reported antimicrobial usage, with 55% linking data to resistance rates and 49% linking data to infection rates. Only 20% had electronic prescribing for all patients. A total of 89% of programmes educated their medical, nursing and pharmacy staff on AMS. Of the hospitals, 38% had formally reviewed their AMS programme: reductions were reported by 96% of hospitals for inappropriate prescribing, 86% for broad-spectrum antibiotic use, 80% for expenditure, 71% for healthcare-acquired infections, 65% for length of stay or mortality and 58% for bacterial resistance. Conclusions The worldwide development and implementation of AMS programmes varies considerably. Our results should inform and encourage the further evaluation of this with a view to promoting a worldwide stewardship framework. The prospective measurement of well-defined outcomes of the impact of these programmes remains a significant challenge.

Published
2015

2. Impact of a region wide antimicrobial stewardship guideline on urinary tract infection prescription patterns

Author

Danièle Sekri, Xavier Bertrand, C. Slekovec, Nathalie Vernaz-Hegi, Bruno Hoen, Daniel Talon, J. Leroy, Jean-Pierre Faller, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Hôpital Jean Minjoz, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques

Subjects
Health Knowledge, Attitudes, Practice, Antibiotics, MESH : Drug Prescriptions, MESH: Health Knowledge, Attitudes, Practice, MESH : Aged, MESH: Urinary Tract Infections, Toxicology, MESH: Regression Analysis, MESH : General Practitioners, MESH : Guideline Adherence, 0302 clinical medicine, MESH : Physician's Practice Patterns, Anti-Infective Agents, MESH : Regression Analysis, Medicine, Pharmacology (medical), MESH : Urinary Tract Infections, Practice Patterns, Physicians', MESH: Drug Utilization, 0303 health sciences, MESH: Program Evaluation, MESH : Education, Medical, Continuing, MESH: Middle Aged, 3. Good health, MESH : Practice Guidelines as Topic, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Young Adult, MESH: Guideline Adherence, MESH : Anti-Infective Agents, Regression Analysis, Education, Medical, Continuing, Guideline Adherence, medicine.medical_specialty, MESH : Fosfomycin, Attitude of Health Personnel, Urinary system, MESH: Attitude of Health Personnel, MESH : Young Adult, Pharmacy, Drug Prescriptions, 03 medical and health sciences, MESH : Adolescent, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Humans, MESH : Middle Aged, MESH : Norfloxacin, MESH: Physician's Practice Patterns, Norfloxacin, Aged, Pharmacology, MESH: Adolescent, MESH: Humans, 030306 microbiology, MESH : Humans, MESH: Adult, Guideline, MESH: Education, Medical, Continuing, Nitrofurantoin, MESH: Female, MESH : Attitude of Health Personnel, Pediatrics, Time Factors, MESH : Health Knowledge, Attitudes, Practice, Pharmaceutical Science, MESH : Drug Utilization, MESH: Fosfomycin, MESH: Practice Guidelines as Topic, MESH: Drug Prescriptions, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Antimicrobial stewardship, MESH : Female, 030212 general & internal medicine, MESH: Aged, MESH : Adult, Middle Aged, MESH: General Practitioners, MESH : Program Evaluation, Practice Guidelines as Topic, Urinary Tract Infections, MESH: Nitrofurantoin, Female, France, medicine.drug, MESH : Time Factors, Adult, MESH: Norfloxacin, Adolescent, medicine.drug_class, MESH: Anti-Infective Agents, Young Adult, Fosfomycin, General Practitioners, Internal medicine, MESH : Nitrofurantoin, Medical prescription, MESH : France, business.industry, MESH: Time Factors, Drug Utilization, MESH: France, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Program Evaluation
Abstract

International audience; BACKGROUND: Fluoroquinolones are frequently prescribed for non complicated urinary tract infection treatments and have a negative ecological impact. We aimed to substitute them by antibiotics with narrower activity spectrum in order to preserve fluoroquinolone activity in complicated hospital infections. OBJECTIVE: To assess the impact of a multi-modal approach that combines the dispatching of antibiotic prescription guidelines and voluntary attendance at educational sessions on general practitioners' (GP) antibiotic prescription habits. SETTING: This study was led in Franche-Comté, a French eastern region, where GPs were given a guideline recommending a restricted use of fluoroquinolones for urinary tract infections. METHOD: Segmented regression analysis of interrupted time series was used to assess changes in antibiotic prescription. MAIN OUTCOME MEASURE: The antibiotic prescription data of nitrofurantoin, fosfomycin-trometamol and fluoroquinolones for women aged 15-65 years were obtained from the regional agency of health insurance. RESULTS: Twenty months after intervention, the number of nitrofurantoin and fosfomycintrometamol prescriptions increased by 36.8% (95% CI: 30.6-42.2) and 28.5% (95% CI: 22.9-35.4), respectively, while that of norfloxacin decreased by 9.1% (95% CI: -15.3 to -3.5). CONCLUSION: This study suggests that the dispatch of the guideline on urinary tract infection had a moderate impact on antibiotic prescriptions.

Published
2012

3. A generic system for critiquing physicians' prescriptions: usability, satisfaction and lessons learnt

Author

Jb Lamy, Ebrahiminia, V., BRIGITTE SEROUSSI, Bouaud, J., Simon, C., Favre, M., Falcoff, H., Venot, A., Laboratoire d'Informatique Médicale et Ingénierie des Connaissances en e-Santé (LIMICS), Université Paris 13 (UP13)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Informatique Médicale et de BIOinformatique (LIM&BIO), Université Paris 13 (UP13), Département d'information hospitalier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Société de Formation Thérapeutique du Généraliste (SFTG), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Bouaud, Jacques, Laboratoire d'Informatique Médicale et de BIOinformatique ( LIM&BIO ), Université Paris 13 ( UP13 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Centre de Recherche des Cordeliers ( CRC (UMR_S 872) ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Société de Formation Thérapeutique du Généraliste ( SFTG ), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)

Subjects
MESH : Drug Therapy, Computer-Assisted, FOS: Computer and information sciences, Computer Science - Artificial Intelligence, MESH : Drug Prescriptions, MESH: Drug Therapy, Computer-Assisted, MESH: Algorithms, Drug Prescriptions, Article, Job Satisfaction, MESH: Hypertension, [INFO.INFO-AI]Computer Science [cs]/Artificial Intelligence [cs.AI], Electronic Prescribing, User-Computer Interface, MESH : Job Satisfaction, MESH : Physician's Practice Patterns, Drug Utilization Review, MESH: Drug Utilization Review, MESH : Chronic Disease, MESH : Diabetes Mellitus, Type 2, MESH : Drug Utilization Review, MESH: Drug Prescriptions, MESH : User-Computer Interface, Humans, MESH : Decision Support Systems, Clinical, Practice Patterns, Physicians', MESH : Electronic Prescribing, [ INFO.INFO-AI ] Computer Science [cs]/Artificial Intelligence [cs.AI], MESH: Physician's Practice Patterns, MESH: Job Satisfaction, MESH : Algorithms, [INFO.INFO-BI] Computer Science [cs]/Bioinformatics [q-bio.QM], MESH: User-Computer Interface, MESH: Humans, MESH: Chronic Disease, MESH : Humans, MESH : Hypertension, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Electronic Prescribing, Decision Support Systems, Clinical, Drug Therapy, Computer-Assisted, Artificial Intelligence (cs.AI), Diabetes Mellitus, Type 2, Chronic Disease, Hypertension, MESH: Decision Support Systems, Clinical, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [INFO.INFO-BI]Computer Science [cs]/Bioinformatics [q-bio.QM], Algorithms, MESH: Diabetes Mellitus, Type 2
Abstract

International audience; Clinical decision support systems have been developed to help physicians to take clinical guidelines into account during consultations. The ASTI critiquing module is one such systems; it provides the physician with automatic criticisms when a drug prescription does not follow the guidelines. It was initially developed for hypertension and type 2 diabetes, but is designed to be generic enough for application to all chronic diseases. We present here the results of usability and satisfaction evaluations for the ASTI critiquing module, obtained with GPs for a newly implemented guideline concerning dyslipaemia, and we discuss the lessons learnt and the difficulties encountered when building a generic DSS for critiquing physicians' prescriptions.

Published
2011

4. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

Author

Christine Riou, Christian Simon, Brigitte Séroussi, Jean-Baptiste Lamy, Alain Venot, Stéphane Dubois, Jacques Bouaud, Madeleine Favre, Vahid Ebrahiminia, Antoine Butti, Gérard Simon, Hector Falcoff, Laboratoire d'Informatique Médicale et Ingénierie des Connaissances en e-Santé (LIMICS), Université Paris 13 (UP13)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Informatique Médicale et de BIOinformatique (LIM&BIO), Université Paris 13 (UP13), Département d'information hospitalier, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Modélisation Conceptuelle des Connaissances Biomédicales, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), UPMC - Département de santé publique, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Silk Informatique, Recherches et Etudes en Systèmes Informatiques Professionnels (RESIP), RESIP, Expertise en Système d'Information et de Représentation de l'Information Médicale (ESIRIM), ESIRIM, Société de Formation Thérapeutique du Généraliste (SFTG), We thank the HAS (Haute Autorité de Santé, the French health authority) and the CNAM (Caisse Nationale d'Assurance Maladie, the French health insurance fund for employees) for funding the ASTI project, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), BMC, Ed., Laboratoire d'Informatique Médicale et de BIOinformatique ( LIM&BIO ), Université Paris 13 ( UP13 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Département de santé publique, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Tenon [APHP], Centre de Recherche des Cordeliers ( CRC (UMR_S 872) ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Recherches et Etudes en Systèmes Informatiques Professionnels ( RESIP ), Expertise en Système d'Information et de Représentation de l'Information Médicale ( ESIRIM ), Société de Formation Thérapeutique du Généraliste ( SFTG ), and Bouaud, Jacques

Subjects
Decision support system, 020205 medical informatics, MESH : Translational Medical Research, MESH : Drug Prescriptions, Alternative medicine, MESH: Translational Medical Research, 02 engineering and technology, Health informatics, law.invention, Task (project management), Translational Research, Biomedical, 0302 clinical medicine, MESH : Physician's Practice Patterns, Randomized controlled trial, MESH : Chronic Disease, MESH: Drug Prescriptions, MESH: Practice Guidelines as Topic, law, 0202 electrical engineering, electronic engineering, information engineering, Medicine, 030212 general & internal medicine, Practice Patterns, Physicians', [ SDV.BIBS ] Life Sciences [q-bio]/Quantitative Methods [q-bio.QM], MESH : Algorithms, [INFO.INFO-BI] Computer Science [cs]/Bioinformatics [q-bio.QM], [SDV.BIBS] Life Sciences [q-bio]/Quantitative Methods [q-bio.QM], Health Policy, [SDV.BIBS]Life Sciences [q-bio]/Quantitative Methods [q-bio.QM], 3. Good health, Computer Science Applications, Test (assessment), MESH : Practice Guidelines as Topic, Practice Guidelines as Topic, lcsh:R858-859.7, Algorithms, Research Article, medicine.medical_specialty, Health Informatics, MESH: Algorithms, lcsh:Computer applications to medicine. Medical informatics, Drug Prescriptions, 03 medical and health sciences, MESH: Drug Therapy, Drug Therapy, [ INFO.INFO-BI ] Computer Science [cs]/Bioinformatics [q-bio.QM], Humans, Medical prescription, MESH: Physician's Practice Patterns, MESH : Drug Therapy, Medical education, MESH: Humans, business.industry, MESH: Chronic Disease, MESH : Humans, Guideline, Family medicine, Chronic Disease, [INFO.INFO-BI]Computer Science [cs]/Bioinformatics [q-bio.QM], business
Abstract

Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices.

Published
2010

5. [Evaluation of antibiotic prescription in a French university hospital]

Author

I, Patry, J, Leroy, T, Hénon, D, Talon, B, Hoen, X, Bertrand, Laboratoire de génétique et biologie cellulaire ( LGBC ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -École pratique des hautes études ( EPHE ) -Centre National de la Recherche Scientifique ( CNRS ), Department of pharmacology, University College of London [London] ( UCL ), Institut Tchadien de Recherche Agronomique pour le Développement ( ITRAD ), Ministère de l'Agriculture, de l'Élevage et de la Pêche, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, University College of London [London] (UCL), Institut Tchadien de Recherche Agronomique pour le Développement (ITRAD), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques

Subjects
MESH : International Cooperation, International Cooperation, MESH : Cephalosporins, MESH : Prescriptions, Drug, MESH : Drug Prescriptions, MESH : Hospital Units, MESH: Documentation, Documentation, Penicillins, Drug Prescriptions, Hospitals, University, MESH: Drug Prescriptions, MESH: Penicillins, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, MESH: Anti-Bacterial Agents, MESH : Anti-Bacterial Agents, MESH : France, MESH : Hospitals, University, MESH: Hospitals, University, MESH: Fluoroquinolones, Anti-Bacterial Agents, Cephalosporins, MESH: France, MESH: International Cooperation, [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, MESH: Cephalosporins, MESH : Penicillins, France, MESH: Hospital Units, MESH : Documentation, MESH : Fluoroquinolones, Hospital Units, Fluoroquinolones
Abstract

International audience; OBJECTIVE: The aim of this study was to evaluate antibiotic prescription in a French university hospital. DESIGN: Our hospital participated in an international European Surveillance of Antimicrobial Consumption (ESAC) project study, including a longitudinal survey of monthly antibiotic use between 1998 and 2005, and a point prevalence study in 2006. All patients in the hospital on the day of survey were included in the study. Antibiotic treatments were assessed according to local antibiotic guidelines. RESULTS: Between 1998 and 2005, antibiotic use increased from 551.9 to 628.5 defined daily doses per 1000 patient-days. This increase was linked to the increase of penicillin and fluoroquinolone consumption. In the point prevalence survey, 251 (27.0%) of the 930 included patients received one or several antibiotics for a total of 395 antibiotic prescriptions. Community-acquired infections were the first indication of treatment (41.8% of prescriptions), hospital-acquired infections accounted for 34.9% of prescriptions, surgical and medical antibiotic prophylaxis for 22.4%. The assessment of antibiotic prescriptions showed that 73.7% of them were in conformity with local recommendations. CONCLUSIONS: This type of study is relevant to identify critical points of inadequate antibiotic use so as to suggest corrective measures to prescribers.

Published
2008

6. [Impact of a multidisciplinary approach for monitoring prescribing of antibiotics in a hospital]

Author

Causse, R., Chouaid, C., Callaert, S., Le Paih, M. F., Cohen, R., Thebault, A., Sciences et Technologies de la Musique et du Son ( STMS ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -IRCAM-Centre National de la Recherche Scientifique ( CNRS ), Epidémiologie des maladies infectieuses et modélisation ( ESIM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratoire d'Ecologie Alpine ( LECA ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Université Savoie Mont Blanc ( USMB [Université de Savoie] [Université de Chambéry] ) -Centre National de la Recherche Scientifique ( CNRS ), R Causse, C Chouaid, S Callaert, Le Paih MF, Cohen R, A Thebault, Annesi-Maesano, Isabella, Sciences et Technologies de la Musique et du Son (STMS), Institut de Recherche et Coordination Acoustique/Musique (IRCAM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Epidémiologie des maladies infectieuses et modélisation (ESIM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Ecologie Alpine (LECA), Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), and Université Joseph Fourier - Grenoble 1 (UJF)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Inservice Training, Cost Control, MESH : Drug Prescriptions, MESH : Inservice Training, MESH : Medical Audit, Health Services Misuse, MESH: Medical Audit, Drug Prescriptions, Drug Costs, MESH : Drug Costs, MESH : Drug Utilization, MESH : Cost Control, MESH : Hospital Costs, MESH: Patient Care Team, MESH: Drug Prescriptions, MESH : Child, MESH: Anti-Bacterial Agents, MESH: Child, MESH: Drug Costs, Humans, MESH : Health Services Misuse, MESH: Drug Utilization, Hospital Costs, MESH : Anti-Bacterial Agents, Child, MESH : France, MESH: Hospital Costs, Patient Care Team, Cross Infection, Medical Audit, MESH: Humans, MESH : Patient Care Team, MESH: Cost Control, MESH : Humans, MESH: Cross Infection, MESH: Adult, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, MESH: Health Services Misuse, MESH: Inservice Training, Drug Utilization, Anti-Bacterial Agents, MESH: France, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, MESH : Cross Infection
Abstract

International audience; OBJECTIVE: The aim of this study was to examine the impact of a rationalized antibiotic prescription program in a 600-bed hospital. PATIENTS AND METHODS: The program was based on a local consensus policy, developed with the prescribers themselves, together with individual nominative dispensing (IDN) of the most costly antibiotics, and training/information programs aimed at institutional prescribers. The impact of the program was assessed in terms of the relevance of prescriptions (6-monthly audits), changes in the overall cost of anti-infectives, the average daily cost per hospital patient, and changes in the pattern of antimicrobial resistance among pathogens isolated in the institution. RESULTS: Reference recommendations were established for most clinical settings encountered in the hospital (104 for adults, 78 for children). The four audits conducted since June 1996 show that the rate of unjustified prescriptions has remained below 6%. The cost of antimicrobials has fallen regularly, both in absolute terms and as a proportion of total drug costs. Finally, resistance rates among the different pathogens studied have fallen or remained stable. CONCLUSION: Rationalization of antimicrobial chemotherapy in a short-stay hospital necessitates an institution-based policy with long-term objectives, a large initial investment and, above all, a participative approach among all prescribers.

Published
1998

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