Antimicrobial stewardship program and quality of antibiotic prescriptions

National recommendations have been issued to define which optimal organization in hospitals could improve the quality of antibiotic prescription. Our aim was to check whether there was a link between applying these national recommendations and the quality of antibiotic prescriptions.

A prospective study was carried out in three French regional hospitals (A to C), to assess how recommendations were applied. Hospital organization was measured with the ICATB score (antimicrobial stewardship index) and the appropriateness of antibiotic prescription was assessed by an audit during 1 week by two investigators, who shadowed physicians during bedside visits, in various medical and surgical departments.

There was a considerable difference in the organization of these three hospitals in terms of computerized prescriptions, formulary restriction, availability of recommendations, and antibiotic consumption defined as delivered daily-dose. Institution A had strictly followed recommendations for hospital organization, but these were less observed in institution B and C. The prevalence of antibiotic treatment was comparable in the three hospitals, and concerned over 25% of patients. In institution A, 60% of antibiotic prescriptions were inadequate, 23% were not appropriate and 17% were optimal. In institution B, these figures reached 36%, 34%, and 34%, while in institution C they reached 25%, 55%, and 20%, respectively.

There is no clear link between applying national recommendations for antibiotic prescription and optimization of hospital organization and the quality of antibiotic prescriptions.