title: [Distribution of antimicrobial guidelines: useful but not enough for an antibiotic stewardship].
abstract: OBJECTIVE
  Evaluate the impact of distribution of antimicrobial guidelines (AG) on anti-infectious prescriptions (AIP) in patients presenting a bacteraemia. Cost evaluation of AIP with and without intervention of an infectious disease specialist.
  
  
  METHODS
  The first evaluation of AIP was performed from January to May 2008 in Douai hospital, France, at day 4 after the initial blood sample using French guidelines (FG). An AG based on FG was distributed in June 2008 to all Medical Doctors. A second evaluation of AIP was performed from July 2009 to October 2010 after AG distribution. In May 2009, an infectious disease specialist arrived. He re-evaluated at day 4 the initial AIP and modified it if necessary based on the bacteriologic results and the AG. In the second period of the study, we evaluated the cost of the AIP after day 4.
  
  
  RESULTS
  Anti-infectious at day 1 was suitable in 37/50 (74%) cases before vs. 148/206 (72%) cases after distribution of the AG (P = 0.76). At day 4, anti-infectious was suitable in 26/50 (52%) before vs. 103/206 (50%) cases after distribution of the AG (P = 0.80). In the second period, the overall cost of AIP was estimated at 44,000 Euros with the infectious disease specialist intervention and at 51,000 Euros without.
  
  
  CONCLUSIONS
  Distribution of AG did not significantly improve AIP in patients with bacteraemia. Re-evaluation by an infectious disease specialist could lead to a better anti-infectious usage and potential reduction in costs.
authors.affiliation: Centre hospitalier Douai, Infectious Diseases Department, 59500 Douai, France. Electronic address: xljhe@yahoo.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Lemaire
authors.affiliation: Dron Hospital of Tourcoing, Infectious Diseases Department, 59200 Tourcoing, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Robineau
authors.affiliation: Centre hospitalier Douai, Infectious Diseases Department, 59500 Douai, France; Dron Hospital of Tourcoing, Infectious Diseases Department, 59200 Tourcoing, France.
authors.forename: Anne Laure
authors.initials: AL
authors.lastname: Blanc
authors.affiliation: Centre hospitalier Douai, Infectious Diseases Department, 59500 Douai, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Vialle
authors.affiliation: Centre hospitalier Douai, Infectious Diseases Department, 59500 Douai, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Béguec
authors.affiliation: Centre hospitalier Douai, Microbiology Laboratory, 59500 Douai, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Hendricx
authors.affiliation: Hospital Bichat, Infectious Diseases Department, 75018 Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: Centre hospitalier Douai, Infectious Diseases Department, 59500 Douai, France.
authors.forename: Loubna
authors.initials: L
authors.lastname: El Mansouf
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D005602:France; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies
chemical_list: D000890:Anti-Infective Agents