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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
[Audit on antibiotic prescriptions in a department of infectious diseases]
Jean-Ralph Zahar1, Parinaz Ghaffari, Isabelle Kamga
1Inserm U 570, Unité de pathogénie des infections systémiques, Faculté de médecine Necker-Enfants malades, Paris (75). zahar@necker.fr
Objectives:
France is one of the countries that prescribe the most antibiotics. The inappropriate use of antibiotics participates in the emergence of multi-resistant bacteria. This study was aimed at assessing the adequation of antibiotic prescriptions in a hospital department of internal medicine-infectious diseases.
Methods:
Over a two-month period, all the antibiotics treatments were analysed prospectively. The adequation of the treatments was analysed at first with regard to the various consensus conferences of the French-speaking Society of infectious diseases (Société de pathologie infectieuse de langue française (Spilf)) and then with regard to the bacteriological results.
Results:
One hundred and five prescriptions were analysed during the study period. Thirty-five percent of prescriptions were inadequate with regard to the criteria used. In 22 cases the prescription was excessive, in 8 cases it was unjustified and in 5 cases it was inappropriate. Moreover, in univariate analysis, 3 factors were correlated with inadequation: prescriptions drawn-up by a non-infectious disease practitioner (OR =3.45, IC 95% 1.34-9.09, p=0.008), prescriptions drawn-up by junior in the department (OR =4.10, IC 95% 1.54-11.08, p=0.003) and prescriptions pour respiratory infections (OR=2.58, IC 95% 1.03-6.48, p =0.04).
Conclusion:
This study conducted in a department of infectious diseases reveals the persisting high rate of inappropriate prescriptions, confirming the need to develop control and retro-control strategies regarding the prescription of antibiotics in order to control the diffusion of multi-resistant bacteria.
Insights
Thirty-five percent of antibiotic prescriptions were inadequate, with non-infectious disease practitioners and junior doctors more likely to prescribe inappropriately. This highlights the need for antibiotic stewardship to combat multi-resistant bacteria.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Public Health
Context:
- France exhibits high antibiotic prescription rates, contributing to multi-drug resistant bacteria.
- Inappropriate antibiotic use is a significant global health concern.
- Hospital internal medicine-infectious diseases departments face challenges in optimizing antibiotic therapy.
Purpose:
- To assess the appropriateness of antibiotic prescriptions in a hospital internal medicine-infectious diseases department.
- To identify factors associated with inadequate antibiotic prescribing.
- To inform strategies for reducing antibiotic resistance.
Summary:
- A prospective analysis of 105 antibiotic prescriptions revealed that 35% were inadequate.
- Inadequacies included excessive, unjustified, and inappropriate prescriptions.
- Factors linked to inadequate prescribing were non-specialist prescribers, junior doctors, and respiratory infections.
Impact:
- Findings underscore the persistent issue of inappropriate antibiotic prescribing.
- The study emphasizes the critical need for enhanced antibiotic control and monitoring strategies.
- Reducing inappropriate prescriptions is vital for controlling the spread of multi-resistant bacteria.
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