[Compliance to the antibiotic committee guidelines in Tourcoing Hospital]

We evaluated the compliance to the antibiotic committee guidelines of Tourcoing Hospital.

A national nosocomial infections prevalence study was conducted in June 2006. We collected additional data on the name and indication of prescribed antibiotics compared to recommended drugs in our therapeutic guidelines. Endpoints were antibiotic indication, compliance to local guidelines, unjustified combination therapy and deescalation therapy if possible. Situations non included in the guidelines were evaluated on a case to case basis after discussion with the prescribing physician. Pediatric (N=5) or prophylaxis (N=4) prescriptions were not analysed.

Antibiotics were used in 97/669 (14.5%) patients including 32% in acute care, 11% in rehab and 0,9% in long term care. Drugs recommended in the guidelines were used in 63 cases (60.5%) including 56.3% first line and 4.2% justified second line therapy. When including situations not included in the guidelines and judged as correct, compliance reached 64.9%. The 41 variations from guidelines observed in 34 patients concerned: molecule choice (N=12), lack of antibiotic indication (N=12), unjustified combination therapy (N=12), drug choice in combination therapy (N=5), lack of deescalation (N=1). Lower respiratory tract (N=12) and urinary tract (N=7) infections as well as fluoroquinolones (N=12) were the most frequent deviations from guidelines.

Compliance rate is encouraging. This study pinpoints specific targets for future interventions.