[Lung diseases in the elderly. Assessment of guidelines for the probabilistic prescription of antibiotics in a department of geriatric care].
OBJECTIVE
We developed a prescribing guideline containing recommendations for the initial empirical antibiotic therapy in community or nosocomial pneumonia. The aim of the present study was to examine the impact of this measure.


METHODS
The prescribing guideline was implemented in May 1999. We retrospectively reviewed the charts of all patients>65 years with community-, or nursing home- or hospital-acquired pneumonia hospitalised in our department of acute geriatric care between May 1999 and November 2000. The criteria assessed were: consistence with the guideline, clinical effectiveness within 72 hours, adequation with the isolated germs and intra-hospital mortality.


RESULTS
Data were collected on 112 patients (63 women et 49 men; mean age=80 +/- 8 Years). The pneumonia was community-acquired in 52 cases (46%), nursing home acquired in 25 cases (22%) and hospital-acquired in 35 cases (31%). Antibiotic prescription was consistent with the guideline in 64 cases (57%). When the antibiotic therapy was consistent, the patients were more likely to improve within 72 hours (45/64 versus 23/48; p=0.01). Despite a tendency, the number of antimicrobial treatments adapted to the isolated microorganisms was not significantly higher in the consistent group (22/36 adapted treatments versus 10/20). The intra-hospital mortality (25%) was similar in the two groups consistent and not consistent with the guideline. SARM was the most frequent multiresistant bacteria that was isolated.


CONCLUSIONS
The use of a prescribing guideline might improve the efficiency of empirical probabilistic antibiotic therapies. The impact of the guideline use on overall antibiotic costs and microbiological flora remains to be determined.
Huvent-Grelle
Dominique
D
Service de médecine interne et gériatrie, Hôpital gériatrique, Les Bateliers, CHRU de Lille. d.huvent@chru-lille.fr
Puisieux
François
F
Tettart-Hevin
Kathleen
K
Tettart
Vincent
V
Bulckaen
Hélène
H
Simovic
Bénédicte
B
Leroy
Olivier
O
Dewailly
Philippe
P
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D015577:Geriatric Assessment; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents