title: Audit of antibiotic therapy used in 66 cases of endocarditis.
abstract: OBJECTIVE
  We wanted to assess the quality of antibiotic therapy prescribed for infective endocarditis in our ward.
  
  
  METHODS
  We conducted a retrospective audit of all adult patients with endocarditis hospitalized over a 3-year period in the Infectious Diseases Unit of the Nice University Hospital, France. The quality of antibiotic therapy was assessed using the 2004 European Society of Cardiology guidelines as a reference. Antibiotic therapy was considered as appropriate only if the five following items complied with guidelines: antibiotic, dose, route, interval of administration, and duration of antibiotic treatment.
  
  
  RESULTS
  Sixty-six patients were included, 63years of age on average. Antibiotic therapy complied with guidelines in 14% of the cases. The most frequent causes of inappropriate therapy were: gentamicin prescribed as a single daily dose in 55% (27/49) of the cases, unnecessary prescriptions of rifampin in 72% (18/25) of the cases, and too long duration of gentamicin course for staphylococcal endocarditis in 32% (9/28) of the cases. Antibiotic therapy was switched from intravenous to oral route in 29% of the patients (n=19), 18±9 days after starting therapy on average. These endocarditis were mainly left-sided (n=12) and/or complicated (n=15). There was no significant association between mortality and inappropriate antibiotic therapy (14% if inappropriate vs. 22%, P=0.62) or between mortality and oral switch (0% if oral switch vs. 21%, P=0.052).
  
  
  CONCLUSIONS
  Infective endocarditis antibiotic treatment rarely complied with the 2004 European guidelines, but this did not have a negative impact on mortality. Switching antibiotic therapy from intravenous to oral route was common, even for complicated left-sided endocarditis, and was associated with a favorable outcome in all cases.
authors.affiliation: Service d'infectiologie, hôpital l'Archet 1, CHU de Nice, 151, route Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice cedex 3, France.
authors.forename: E
authors.initials: E
authors.lastname: Demonchy
authors.forename: P
authors.initials: P
authors.lastname: Dellamonica
authors.forename: P M
authors.initials: PM
authors.lastname: Roger
authors.forename: E
authors.initials: E
authors.lastname: Bernard
authors.forename: E
authors.initials: E
authors.lastname: Cua
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006757:Hospital Units; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing; D055552:Infectious Disease Medicine / Q000458:organization & administration; D007262:Infusions, Intravenous; D008297:Male; D008485:Medical Audit; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents