title: Does nonadherence to local recommendations for empirical antibiotic therapy on admission to the intensive care unit have an impact on in-hospital mortality?
abstract: OBJECTIVE
  1/ To evaluate if empirical antibiotic prescription on admission to our intensive care unit (ICU) respects the local recommendations for antibiotic prescription and to identify predictors of nonadherence to these guidelines. 2/ To assess whether nonadherence to the guidelines is associated with increased in-hospital mortality due to the initial infection.
  
  
  METHODS
  This was a prospective six-month observational study performed in a 14-bed medical ICU. Patients were included if they received curative antibiotic therapy on admission. Respect of the local treatment recommendations was evaluated according to adherence to the local empirical guidelines defined in a 80-page booklet which is given in our hospital to every physician.
  
  
  RESULTS
  Among 132 antibiotic prescriptions, 21 (16%) were unjustified (absence of infection), 17 (13%) were microbiologically documented at admission, and nine (7%) were given for infections from unknown origin. Among the 85 (64%) empirical prescriptions that could be evaluated for adherence to local recommendations, nine (11%) were inappropriate and 76 (89%) appropriate. In univariate analysis hospital-acquired infection was the sole predictor of inappropriate treatment (p = 0.0475). Independent predictors of in-hospital mortality due to the initial infection were inappropriate empirical treatment (odds ratio [OR] = 14.64, 95% confidence interval [CI]: 2.17-98.97; p = 0.006), prescription of fluoroquinolones (OR = 8.22, 95% CI: 1.88-35.95; p = 0.005) and a higher Simplified Acute Physiology Score II score (per one-point increment (OR = 1.04, 95% CI: 1.01-1.07; p = 0.02).
  
  
  CONCLUSIONS
  Nonadherence to local empirical antibiotic therapy guidelines was associated with increased in-hospital mortality due to the initial infection.
authors.affiliation: Service de Réanimation Médicale.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Baudel
authors.forename: Jacques
authors.initials: J
authors.lastname: Tankovic
authors.forename: Fabrice
authors.initials: F
authors.lastname: Carrat
authors.forename: Cécile
authors.initials: C
authors.lastname: Vigneau
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.forename: Valérie
authors.initials: V
authors.lastname: Lalande
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
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