title: Impact of an assisted reassessment of antibiotic therapies on the quality of prescriptions in an intensive care unit.
abstract: OBJECTIVE
  The study's objective was to assess the impact of a professional multifaceted intervention designed to improve the quality of inpatient empirical therapeutic antibiotic courses at the time of their reassessment, i.e. 24 to 96 hours after treatment initiation.
  
  
  METHODS
  We conducted a 5-month prospective pre- and post-intervention study in a medical Intensive Care Unit (ICU) in a teaching hospital, using time-series analysis. The intervention was a multifaceted professional intervention combining systematic 3-weekly visits of an infectious diseases specialist to discuss all antibiotic therapies, interactive teaching courses, and daily contact with a microbiologist.
  
  
  RESULTS
  Eighty-one antibiotic prescriptions were assessed, 37 before and 44 after the intervention. The prevalence of adequate antibiotic prescriptions was high and not statistically different before and after the intervention (73% vs. 80%, P=0.31), both for sudden change (P=0.67) and linear trend (P=0.055), using interrupted time-series analysis. The intervention triggered a more frequent reassessment of the diagnosis between day 2 and day 4 (11% vs. 32%, P=0.02) and slightly improved the adaptation of antibiotic therapies to positive microbiology (25% before vs. 50% after, P=0.18).
  
  
  CONCLUSIONS
  Our multifaceted intervention may have improved the quality of antibiotic therapies around day 3 of prescription, but the difference did not reach statistical significance, possibly because of a ceiling effect.
authors.affiliation: Service de réanimation médicale, hôpital l'Archet-1, CHU de Nice, 151 route Saint-Antoine-de-Ginestière, Nice cedex 3, France.
authors.forename: L
authors.initials: L
authors.lastname: Bornard
authors.forename: J
authors.initials: J
authors.lastname: Dellamonica
authors.forename: H
authors.initials: H
authors.lastname: Hyvernat
authors.forename: F
authors.initials: F
authors.lastname: Girard-Pipau
authors.forename: N
authors.initials: N
authors.lastname: Molinari
authors.forename: A
authors.initials: A
authors.lastname: Sotto
authors.forename: P-M
authors.initials: PM
authors.lastname: Roger
authors.forename: G
authors.initials: G
authors.lastname: Bernardin
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D054869:Clinical Audit; D003953:Diagnosis-Related Groups; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004502:Education, Medical, Continuing / Q000458:organization & administration; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D055552:Infectious Disease Medicine; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008829:Microbiology; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement; D019564:Unnecessary Procedures
chemical_list: D000900:Anti-Bacterial Agents