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De-escalation and conformity with guidelines during the treatment of urinary tract infections by general practitioners in Ille-et-Vilaine (France). Part 1, conformity with the guidelines
info:eu-repo/semantics/OpenAccess
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Title:
De-escalation and conformity with guidelines during the treatment of urinary tract infections by general practitioners in Ille-et-Vilaine (France). Part 1, conformity with the guidelines
Author:
Robert, Mathieu
Subjects:
[SDV]Life Sciences [q-bio]
;
Antibiothérapie
;
Appareil urinaire -- Infections
;
Désescalade
;
MESH: Antibactériens
;
MESH: Infections urinaires
;
MESH: Résistance bactérienne aux médicaments
;
Recommandations sur le bon usage des médicaments
;
Résistance aux médicaments
Description:
Introduction. De-escalation is a tool to fight against antibiotic resistance et can be defined as the replacement of the initial antibiotic by a molecule with a narrow antibacterial spectrum after getting the results of the bacteriological documentation. The aims of the study are to assess the rate of antibiotic switch and the relevance of antibiotic prescriptions in the treatment of UTI by general practitioners (GP). Material & methods. This observational multicentric study concerned adult subjects doing a urine culture in medical laboratories in Ille-et-Vilaine (France) and starting an empirical antibiotic treatment. Data was collected from the 22nd of November to the 8th of December of 2018 and from the 10th of January to the 2nd of February of 2019. The study outcomes were the conformity rates of the initial antibiotic and the duration of the efficient antibiotic treatment to the 2014 and 2017 guidelines as well as the rate of antibiotic switch after reception of the antibiogram. Results. 163 urine cultures were collected and we included 95 of them. The global rates of conformity of the initial antibiotic with the 2014 and 2017 guidelines were respectively 65.3% and 67.4%, and 81.9% and 78.6% for the duration of the efficient antibiotic treatment. Among them, 31 were not uncomplicated cystitis and opened the possibility of an antibiotic switch. On the antimicrobial susceptibility test results it was possible in 54.8% of the cases and was performed in 9.7% of the cases. Discussion. This study shows the lack of antibiotic switch in UTI in general medicine. The relatively high rates of conformity of the antibiotic treatment with the guidelines need to be put in perspective because of the important proportion of uncomplicated cystitis treated in most cases by a single-dose of fosfomycin. Introduction. La désescalade est un moyen de lutte contre l’antibiorésistance et se définit comme le remplacement de l’antibiotique initial par une molécule à spectre antibactérien plus étroit après documentation bactériologique. Les objectifs de l’étude sont d’évaluer la désescalade et le respect des recommandations de la SPILF dans les IU traitées en médecine générale. Matériel et méthodes. Cette étude observationnelle multicentrique concernait des sujets majeurs réalisant un ECBU dans des laboratoires d’analyses d’Ille-et-Vilaine et débutant un traitement probabiliste. Le recueil a été réalisé du 22 novembre au 8 décembre 2018 et du 10 janvier au 2 février 2019. Les critères de jugement étaient le taux de conformité de l’antibiotique probabiliste et de la durée de l’antibiothérapie aux recommandations de la SPILF de 2014 et de 2017 ainsi que le taux de désescalade après obtention de l’antibiogramme. Résultats. 163 ECBU ont été recueillis dont 95 ont été inclus. Les taux globaux de conformité de la molécule probabiliste aux recommandations 2014 et de 2017 étaient respectivement 65,3% et de 67,4%, et de 81,9% et 78,6% pour la durée de l’antibiothérapie efficace. Parmi eux, 31 n’étaient pas des cystites aiguës simples et ouvraient la possibilité d’une désescalade. A la lecture de l’antibiogramme, celle-ci était possible dans 54,8% des cas et a été réalisée dans 9,7% des cas. Discussion. Cette étude montre l’insuffisance de réalisation de la désescalade dans les IU prises en charge en médecine générale. Les taux relativement élevés de conformité des antibiothérapies aux recommandations sont à relativiser au regard de la proportion importante de cystites aiguës simples qui dans la majorité des cas ont été traitées par fosfomycine en monodose.
Publisher:
HAL CCSD
Creation Date:
2019
Language:
French
Source:
Dumas (Dépôt Universitaire de Mémoires Après Soutenance)
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