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[Systematic infection consultation in the intensive care unit. Impact of short-term antibiotic use]
P M Roger1, H Hyvernat, S Verleine-Pugliese
1Service des Maladies infectieuses et tropicales, Hôpital de l'Archet, Centre Hospitalo-Universitaire de Nice.
Objectives:
Multiresistant bacteria are regularly isolated in nosocomial infections occurring in intensive care units due to wide use of antibiotics. We evaluated the impact of systematic infectiology consultations on the quality of antibiotic prescriptions in an intensive care unit.
Patients And Methods:
Infectiology consultations (3 per week) were initiated mid February 1999. The infectiologist gave oral advice to be implemented (or not) by the intensive care unit according to ongoing therapeutic options. The hospital pharmacy recorded antibiotic use for March and April 1999 for comparison with use recorded in 1998 for a similar period. We retrospectively reviewed the files of patients hospitalized during these periods and who had received antibiotics to determine the modalities of antibiotic use. The 4 antibiotics used for the longest period for each patient were recorded.
Results:
Thirty-one patients in 1999 and 30 in 1998 were given antibiotics. The SAPS score was similar for the two groups. Mean duration of antibiotic treatment was lower during the March-April 1999 period than during the corresponding period in 1998: 13 +/- 9 days/patient versus 23 +/- 21 days/patient respectively, p = 0.037. In 1998, there were 596 antibiotic-days and in 1999 there were 455 (-24%). The cost of antibiotic therapy in 1998 was 70,342 FrF compared with 56,804 FrF in 1999 (-19%).
Conclusion:
Infectiology consultation, in association with the opinion of the intensive care physician, is a simple way to limit antibiotic use.
Insights
Systematic infectiology consultations significantly reduced antibiotic use and costs in intensive care units. This approach, involving collaboration between infectious disease specialists and ICU physicians, proved effective in optimizing antibiotic prescriptions.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Critical Care Medicine
Context:
- Nosocomial infections in intensive care units (ICUs) are often caused by multiresistant bacteria.
- Widespread antibiotic use contributes to the emergence of antibiotic resistance.
- Optimizing antibiotic prescribing is crucial for infection control in ICUs.
Purpose:
- To evaluate the impact of systematic infectiology consultations on antibiotic prescription quality in an ICU.
- To assess changes in antibiotic consumption and associated costs following the implementation of consults.
Summary:
- Infectiology consultations (3/week) were implemented in an ICU in February 1999.
- Antibiotic use (days and cost) was compared between March-April 1999 and the same period in 1998.
- Mean treatment duration decreased from 23 days (1998) to 13 days (1999), with a 24% reduction in antibiotic-days and a 19% cost decrease.
Impact:
- Systematic infectiology consultations effectively reduced antibiotic consumption and expenditure in the ICU.
- This collaborative approach between infectious disease specialists and ICU physicians offers a simple method for limiting antibiotic use.
- The findings support the integration of infectious disease expertise into ICU antibiotic stewardship programs.