title: Factors associated with effective reassessment of antibiotic therapy on day 3.
abstract: Reassessment of antibiotic therapy (RA) after 3 days is constitutive of French antibiotic stewardship. This delay is required because of the need for clinical reappraisal and for obtaining microbiological data. Our aim was to determine the factors associated with an effective RA.
  
  
  METHODS
  A prospective study was made in a 350-bed general hospital in which all prescriptions are computerized and validated daily by prescribers. All curative antibiotic therapies were reassessed during 4 weeks. RA was defined as effective if the initial antibiotic treatment was modified. All clinical, biological, and radiological data having contributed to the initial prescription and to RA were recorded during bedside visit with the prescribers, two hospital physicians and one infectious diseases specialist.
  
  
  RESULTS
  In one month, 148 antibiotic treatments were reassessed. Pulmonary, digestive, and urinary infections accounted for two thirds of the cases. An effective RA was recorded in 28 cases (19%) and associated with hospitalization in the ICU (P=0.001), imaging supporting the diagnosis (P=0.016), and persistence or aggravation of clinical signs (P=0.007). Microbiological findings were not contributive to an effective RA.
  
  
  CONCLUSIONS
  RA was associated to hospitalization in the ICU, to an inflammatory syndrome, and to the clinical outcome after 3 days. These results should help to improve the implementation of infectious diseases advice.
authors: Service d'Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, BP 3079, 06202 Nice Cedex 3, France. roger.pm@chu-nice.fr
authors: P-M
authors: PM
authors: Roger
authors: C
authors: C
authors: Labate
authors: S
authors: S
authors: Serre
authors: C
authors: C
authors: Zumbo
authors: L
authors: L
authors: Valério
authors: H
authors: H
authors: Bonnet
authors: A
authors: A
authors: Jurado
authors: N
authors: N
authors: Bélé
authors: P
authors: P
authors: Brofferio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D019985:Benchmarking; D003953:Diagnosis-Related Groups; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D057915:Drug Substitution; D005260:Female; D005602:France; D006769:Hospitals, General; D006801:Humans; D007249:Inflammation; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents