title: [Local guidelines and quality of antibiotic treatment in urinary tract infections: a clinical audit in two departments of a university hospital].
abstract: OBJECTIVE
  To assess the effect of local guidelines implemented at the Nantes University Hospital regarding antibiotic therapy for urinary tract infections.
  
  
  METHODS
  Before/after study of one medical ward and one urologic surgery ward. Quality was measured by two principal criteria: compliance with guidelines and medical justification in the specific clinical situation. Both criteria considered simultaneously the choice of drug, dose and duration of treatment. Deviations from the guidelines were described.
  
  
  RESULTS
  1086 UTI cases were identified over two 12-month periods, before and after the dissemination of guidelines (for prostatitis, pyelonephritis, indwelling catheter-associated UTIs, and other undefined UTIs). The guidelines were applicable in 313 (30%) cases. Overall, after implementation of the guidelines, the percentage of justified prescriptions did not change significantly (41.8% compared with 38.7%, p=0.299), but the percentage of correct (conforming) prescriptions fell (from 30.4% to 15.7%, p=0.0022). The percentages of correct and justified prescriptions differed in the medical (respectively 45.0% and 46.6%,) and surgical units (13.1% and 36.5%).
  
  
  CONCLUSIONS
  Issuing guidelines does not necessarily improve the quality of antibiotic therapy for UTIs in hospitals.
authors.affiliation: UPRES EA 1156, Thérapeutiques cliniques et expérimentales des maladies infectieuses, Faculté de médecine de Nantes (44).
authors.forename: I
authors.initials: I
authors.lastname: Arnaud
authors.forename: D
authors.initials: D
authors.lastname: Elkouri
authors.forename: J-M
authors.initials: JM
authors.lastname: N'Guyen
authors.forename: Y
authors.initials: Y
authors.lastname: Foucher
authors.forename: G
authors.initials: G
authors.lastname: Karam
authors.forename: J-Y
authors.initials: JY
authors.lastname: Lepage
authors.forename: M
authors.initials: M
authors.lastname: Billard
authors.forename: G
authors.initials: G
authors.lastname: Potel
authors.forename: P
authors.initials: P
authors.lastname: Lombrail
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005602:France; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents