[Prospective assessment of glycopeptides prescriptions in a general hospital].
OBJECTIVE
The authors had for aim to analyze the indications, quality, and volumes of glycopeptide (GP) prescriptions in all in-patient units of a general hospital. CLINICAL MATERIAL AND METHODOLOGY: A 4 month prospective study assessed the compliance of curative and prophylactic treatment prescriptions administered according to guidelines. The assessment criteria were as follows: prescription indicated or not, prescription modalities (administration of loading dose, performing of serum tests, dosage appropriateness, appropriateness with antibiogram data when available).


RESULTS
Over the 46 assessed prescriptions, 84.7% were curative treatments (N = 39), whereas 15.2% (N = 7) were written out for surgical antibioprophylaxis. The prescription incidence and density were, respectively, 0.60 prescription/100 admissions and 20.8 DDJ/1000 hospitalization days, i.e. 24% of the total antibiotics budget. Prescriptions were always indicated for surgical antibioprophylaxis, but met standards in only 14% of cases. As for curative prescriptions, treatments were appropriate in 56.5% of cases, but only 18% met standards. GP use modalities proved incorrect at various levels: non existing load dose and lack of serum tests, subinhibiting daily doses, no dose lowering when possible, exaggerated duration of surgical antibioprophylaxis. Average GP serum levels were 16 mg/L and were higher than the target level in no more than 40% of properly prescribed treatments.


CONCLUSIONS
Prescription modalities and treatment monitoring must be improved, given the development of bacterial resistance.
Levent
T
T
Equipe opérationnelle en hygiène hospitalière, centre hospitalier de Sambre-Avesnois, boulevard Pasteur, 59600 Maubeuge, France. levent@ch.sa.com
Lambiotte
F
F
Vasseur
M
M
De Zorzi
S
S
Gosteau
L
L
Paradis
P
P
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004351:Drug Resistance; D004363:Drug Utilization / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011292:Premedication; D011300:Preoperative Care; D011446:Prospective Studies; D017334:Teicoplanin / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin