title: A comparative study of three methods to evaluate an intervention to improve empirical antibiotic therapy for acute bacterial infections in hospitalized patients.
abstract: BACKGROUND
  In order to limit the use of broad-spectrum antibiotics, standardized empirical therapy against acute bacterial infections has been advocated.
  
  
  METHODS
  Guidelines for acute bacterial infections recommending increased usage of benzylpenicillin and restricted use of fluoroquinolones and cephalosporins have been implemented in Kalmar County, Sweden. We evaluated this strategy by recording therapy in patients with bacteraemia, antibiotic requisition, and point prevalence surveys prior to this intervention and at 6 and 12 months after.
  
  
  RESULTS
  Comparing the methods simultaneously, there was good agreement between them and an overall significant change in antibiotic usage. There was a significant shift from cefuroxime to cefotaxime and a borderline significant increase in the use of benzylpenicillin (p = 0.057). Based on the defined daily dose (DDD), a highly significant decrease in total cefotaxime and cefuroxime usage was observed that was not detected when applying the prescribed daily dose (PDD), which is adapted to local treatment practices. No change was found in mortality in Staphylococcus aureus bacteraemia or the incidence of Clostridium difficile infection.
  
  
  CONCLUSIONS
  We conclude that the implementation of the new guidelines has resulted in a significant change in antibiotic usage, which could be conveniently monitored by antibiotic requisition if PDD is used in addition to DDD.
authors.affiliation: Department of Clinical Microbiology, Kalmar County Hospital, Sweden. thomassc@ltkalmar.se
authors.forename: Thomas
authors.initials: T
authors.lastname: Schön
authors.forename: Lisa Labbé
authors.initials: LL
authors.lastname: Sandelin
authors.forename: Jonas
authors.initials: J
authors.lastname: Bonnedahl
authors.forename: Fredrika
authors.initials: F
authors.lastname: Hedebäck
authors.forename: Annika
authors.initials: A
authors.lastname: Wistedt
authors.forename: Lars
authors.initials: L
authors.lastname: Brudin
authors.forename: Per-Åke
authors.initials: PÅ
authors.lastname: Jarnheimer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D002511:Cephalosporins / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology; D004358:Drug Therapy / Q000379:methods* / Q000592:standards*; D024841:Fluoroquinolones / Q000627:therapeutic use; D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D015994:Incidence; D010400:Penicillin G / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013548:Sweden
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D010400:Penicillin G