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Multidisciplinary evaluation of the conformity to recommendations of the use of carbapenems through the implementation of an Antimicrobial Stewardship Program at the University Hospital of Caen
info:eu-repo/semantics/OpenAccess
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Title:
Multidisciplinary evaluation of the conformity to recommendations of the use of carbapenems through the implementation of an Antimicrobial Stewardship Program at the University Hospital of Caen
Author:
Perron, Jérémy
Subjects:
[SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences
;
Carbapénèmes
;
Recommandations sur le bon usage des médicaments
;
Résistance aux antibiotiques
Description:
Antibiotic resistance has been constantly increasing as a result of the use of antibiotics (ATB). Carbapenems (CBP), often considered as “last resort” ATB, have been used increasingly more frequently, resulting in the emergence of carbapenemases-producing bacteria because of selection pressure, thus creating a risk of therapeutic impasse. The objective of this study is to evaluate the relevance of the initiations of CBP treatments within the University Hospital, through the establishment of a CBP management program. This prospective study lasted for 5 months in the intensive care unit (ICU), the surgery unit and the medical unit, where the conformity to recommendations of each initiation of a carbapenem treatment has been evaluated by an infectious disease specialist. The follow-up to these evaluations has been collected. 104 files were included in the study. The prescriptions have been predominantly empirical (n = 67), for a pulmonary location (n = 36), and were initiated in the intensive care unit (n = 52). The percentage of nonconformity rose up to 18% (n = 19) and the opinion of the infectious disease specialists has complied in 68% of the cases (n = 13). The non-conformity and the average duration of treatment were significantly lower in the case of empirical prescriptions (p < 0.001). The prescriptions of CBP within the medical unit have had a conformity rate which was statistically superior to those of the ICU (p = 0.037). The follow-up of these encouraging results and the sustainability of the ATB management program focused on CBP and other critical anti-infective agents of our institution are decisive tools in order to combat antibiotic resistance. L'antibiorésistance, consécutive à l'utilisation des antibiotiques (ATB), ne cesse de progresser. Les carbapénèmes (CBP) sont alors de plus en plus utilisés et ont pour conséquence l'émergence de bactéries productrices de carbapénèmases par pression de sélection, avec un risque d'impasse thérapeutique. L'objectif de cette étude est d'évaluer la pertinence des initiations de traitements par CBP au sein d'un centre hospitalier universitaire grâce à la mise en place d'un programme de gestion des CBP. Cette étude prospective a duré 5 mois dans des services de réanimation, de chirurgie et de médecine où la conformité aux recommandations de chaque initiation par carbapénème a été évaluée par un infectiologue. Le suivi de ces évaluations a été collecté. 104 dossiers ont été inclus dans l'étude. Les prescriptions ont été majoritairement empiriques (n = 67), de localisation pulmonaire (n = 36) et initiées dans un service de réanimation (n = 52). La non-conformité s'est élevée à 18% (n = 19) et l'avis infectiologique a adhéré dans 68% de ces cas (n = 13). La non-conformité et la durée moyenne de traitement ont été significativement inférieures en cas de prescription empirique (p < 0,001). Les prescriptions de CBP initiées dans les services de médecine ont eu un taux de non-conformité statistiquement supérieur à celles des services de réanimation (p = 0,037). Le suivi de ces résultats encourageants et la pérennisation de ce programme de gestion des ATB sur les CBP et autres anti-infectieux critiques dans notre établissement sont des outils déterminants dans la lutte contre l'antibiorésistance.
Publisher:
HAL CCSD
Creation Date:
2017
Language:
French
Source:
Dumas (Dépôt Universitaire de Mémoires Après Soutenance)
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