title: [Evaluation of initial antibiotic therapy for bacteremia and role of an antibiotic management team for antibiotic stewardship].
abstract: BACKGROUND
  Antibiotic management teams (AMTs) are recommended, but they are rarely implemented in France and their activity seldom evaluated.
  
  
  OBJECTIVE
  The study was made to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSI) and to assess the role of an AMT for improving AT in a 950-bed teaching hospital.
  
  
  METHODS
  A prospective analysis was made of all significant BSIs outside ICU in 2008. AT was assessed by the AMT and change was suggested if deemed necessary: effective if at least one prescribed antibiotic was effective in vitro, and appropriate if consistent with local recommendations.
  
  
  RESULTS
  Of 875 +BCs, 560 were significant, 383 were outside ICU and 344 could be evaluated (170 community-acquired, 124 nosocomial, and 50 healthcare-associated [HCA]). The clinical ward has already initiated an effective and appropriate AT in 128 (37%), inappropriate but effective in 104 (30%), and ineffective or absent in 112 (33%) BSIs. The only independent variable associated with ineffective/absent AT was nosocomial and/or HCA BSI (aOR: 2.71; 95%CI: 1.72-4.27; p<0.001). A recommendation was given and followed in 177/190 (93%) BSIs requiring an intervention. The AMT intervened on the day of the +BC in 256 (84%) cases, the day before the +BC in 12 (4%) cases, and one day later or more in 37 (12%) BSI cases.
  
  
  CONCLUSIONS
  Two third of BSIs were not initially treated by appropriate AT, more often in nosocomial BSI. Recommendation provided by the AMT was followed in 93% of cases.
authors.affiliation: Unité d'hygiène et de lutte conte l'infection nosocomiale, faculté Paris-7, Denis-Diderot, groupe hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
authors.forename: S
authors.initials: S
authors.lastname: Diamantis
authors.forename: C
authors.initials: C
authors.lastname: Rioux
authors.forename: C
authors.initials: C
authors.lastname: Bonnal
authors.forename: E
authors.initials: E
authors.lastname: Papy
authors.forename: É
authors.initials: É
authors.lastname: Farfour
authors.forename: A
authors.initials: A
authors.lastname: Andremont
authors.forename: P
authors.initials: P
authors.lastname: Yeni
authors.forename: É
authors.initials: É
authors.lastname: Bouvet
authors.forename: J-C
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D003663:Decision Trees; D004363:Drug Utilization / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents