title: Antibiotic strategy in severe community-acquired pneumococcal pneumonia.
abstract: OBJECTIVE
  The authors had for aim to make an inventory of antibiotic treatment for severe community-acquired Streptococcus pneumoniae pneumonia and compare local practices to the local and national guidelines.
  
  
  METHODS
  An audit was conducted retrospectively in the Versailles hospital ICU between January 2006 and April 2009. Forty patients were included.
  
  
  RESULTS
  Ninety-three percent had major risk factors for pneumonia. Ninety-eight percent were treated, with the usual empirical treatment (69%) or treatment active against Pseudomonas aeruginosa (31%). Eighty-five percent of empirical treatment complied with the French national guidelines issued by the SPILF and 49% with the local ICU protocol, more restrictive for the choice of the agent and dose. Early de-escalation to amoxicillin was applied to 41% of patients after obtaining results for pneumococcal and Legionella antigen and results of respiratory sample direct examination. For all patients, empirical treatment was reassessed according to culture results: 81% were prescribed amoxicillin. Evaluation showed that 92% of treatment complied with SPILF guidelines and 65% with the local ICU protocol that required adaptation of amoxicillin doses according to MICs; adaptation to severity and BMI was necessary for ten patients. Mortality remained high, at 37%, despite using antibiotics still effective against S. pneumoniae.
  
  
  CONCLUSIONS
  This survey revealed a satisfactory adhesion to recommendations and prompt responsiveness of the team for adjustment of antibiotic therapy. The audit allowed updating the local ICU protocol.
authors.affiliation: Service de pharmacie, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France. aurelie.tomczak@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Le Bris-Tomczak
authors.forename: J-P
authors.initials: JP
authors.lastname: Bedos
authors.forename: C
authors.initials: C
authors.lastname: Billon
authors.forename: F
authors.initials: F
authors.lastname: Samdjee
authors.forename: A
authors.initials: A
authors.lastname: Le Monnier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000942:Antigens, Bacterial / Q000652:urine; D017714:Community-Acquired Infections / Q000188:drug therapy*; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006773:Hospitals, Municipal / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D000658:Amoxicillin