Restricted antimicrobial prescribing in an area of highly prevalent antimicrobial resistance - 02/09/21
, Marina Skouloudi b, Amalia Anastasopoulou a, Antonios Markogiannakis bBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | In total, 67.2% of prescriptions for all restricted antibiotics (rABX) were empirical. |
• | Treatment for severe sepsis or septic shock was the only reason for rABX prescription which was an independent predictor of subsequent multidrug-resistant organism (MDRO) isolation. |
• | Among patients who were prescribed rABX, recent hospitalization had a high negative predictive value for MDRO infection. |
• | Empirical rABX was inadequate in 14% of patients with microbiologically documented infection, illustrating the difficult reduction of rABX empirical use without risking inadequate treatment. |
Abstract |
Objective |
To assess the predictive value for infection with multidrug-resistant organisms (MDROs) of reasons for empirical prescription of restricted antibiotics (rABX), in a setting with high resistance rates.
Methods |
We prospectively studied all rABX prescriptions in a 550-bed tertiary teaching hospital from April 15 to June 14, 2018 and from September 1 to October 30, 2018. Prescribing physicians had to justify their decision by choosing one or more prespecified reasons.
Results |
We reviewed 172 empirical prescriptions of rABX, which accounted for 67.2% of all rABX prescriptions. Stated reasons for empirical prescription of rABX were recent hospitalization (72.7%), escalation due to non-response to previous antimicrobials (47.7%), treatment for severe sepsis/septic shock (45.9%), escalation due to recurrence or deterioration (22.1%), prior MDRO infection (12.8%), and prior MDRO colonization (7.6%). Empirical treatment for septic shock or severe sepsis was the only significant predictor of MDRO isolation (OR=5.26, 95% CI: 1.5–18.4, P=0.009), while recent hospitalization had a high negative predictive value for MDRO (97.4%). Fourteen per cent of microbiologically documented infections were associated with MDROs resistant to the prescribed rABX.
Conclusions |
Empirical treatment for severe sepsis or septic shock was the only independent predictor of MDRO isolation. Recent hospitalization had a high negative predictive value for MDRO infection. The isolation of pathogens resistant to the prescribed rABX suggests that in a setting with widespread antimicrobial resistance, it could be difficult to reduce the empirical use of rABX without risking inadequate treatment.
Le texte complet de cet article est disponible en PDF.Keywords : Antimicrobial stewardship, Antibacterial agents, Antimicrobial resistance, Nosocomial infection
Plan
Vol 51 - N° 6
P. 526-531 - septembre 2021 Retour au numéro
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