[Appropriate use of antibiotics in hospitals. Investigating clinical practices in management of community-acquired pneumonia].
BACKGROUND
The rationalization of medical practices for antibiotic use in hospitals is necessary to improve both the cost-efficiency and effectiveness of health care. This study sought to investigate the impact of implementation of local management guidelines for inpatient community-acquired pneumonia (CAP).


METHODS
This retrospective, comparative study measured the quality of antibiotic prescriptions with the 10-item Medication Appropriateness Index (MAI). Clinical and demographic characteristics, as well as process-of-care and outcome indicators, were recorded for all patients with CAP admitted to a medical ward at the Nantes university hospital during two 12-month periods: before (Period A, 39 patients) and after (Period B, 50 patients) implementation of local guidelines.


RESULTS
The MAI was significantly higher during period B than period A (5.1 points compared with 2.2, p=0.0001). Guideline implementation shortened the mean duration of antibiotic treatment (13.1 versus 16.0 days, p=0.0003) and of intravenous treatment (3.4 versus 4.7 days, p=0.04). The mean duration of hospital stay also fell substantially (7.4 versus 15.0 days, p=0.0001), as did the mean cost of antibiotics (35.4 versus 64.1 euros, p=0.003).


CONCLUSIONS
The MAI confirmed that antimicrobial practices varied significantly and that appropriate local guidelines improved the quality of antibiotic prescriptions and saved hospitalization costs.


CONCLUSIONS
The MAI, which assesses the appropriateness of antibiotic use in hospitals, could be an interesting tool for prospective use as an indicator of quality-of-care improvement and for more efficient use of available health care resources.
Navas
D
D
CHU de Nantes, Hôtel-Dieu.
Caillon
J
J
Potel
G
G
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents