title: Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines.
abstract: OBJECTIVE
  Physicians frequently deviate from guidelines that promote prudent use of antimicrobials. We explored to what extent patient and disease characteristics were associated with compliance with guideline recommendations for three common infections.
  
  
  METHODS
  In a 1-year prospective observational study, 1,125 antimicrobial prescriptions were analysed for compliance with university hospital guidelines.
  
  
  RESULTS
  Compliance varied significantly between and within the groups of infections studied. Compliance was much higher for lower respiratory tract infections (LRTIs; 79%) than for sepsis (53%) and urinary tract infections (UTIs; 40%). Only predisposing illnesses and active malignancies were associated with more compliant prescribing, whereas alcohol/ intravenous drug abuse and serum creatinine levels >130 micromol/l were associated with less compliant prescribing. Availability of culture results had no impact on compliance with guidelines for sepsis but was associated with more compliance in UTIs and less in LRTIs. Narrowing initial broad-spectrum antimicrobial therapy to cultured pathogens was seldom practised. Most noncompliant prescribing concerned a too broad spectrum of activity when compared with guideline-recommended therapy.
  
  
  CONCLUSIONS
  Patient characteristics had only a limited impact on compliant prescribing for a variety of reasons. Physicians seemed to practise defensive prescribing behaviour, favouring treatment success in current patients over loss of effectiveness due to resistance in future patients.
authors.affiliation: Department of Clinical Pharmacology, University Medical Centre Groningen, Netherlands. p.mol@med.umcg.nl
authors.forename: Peter G M
authors.initials: PG
authors.lastname: Mol
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
authors.forename: Rijk O B
authors.initials: RO
authors.lastname: Gans
authors.forename: Prashant V
authors.initials: PV
authors.lastname: Nannanpanday
authors.forename: John E
authors.initials: JE
authors.lastname: Degener
authors.forename: Marian
authors.initials: M
authors.lastname: Laseur
authors.forename: Flora M
authors.initials: FM
authors.lastname: Haaijer-Ruskamp
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007239:Infections / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies
chemical_list: D000890:Anti-Infective Agents