title: Postprescription review improves in-hospital antibiotic use: a multicenter randomized controlled trial.
abstract: Although review of antibiotic therapy is recommended to optimize antibiotic use, physicians do not always perform it. This trial aimed to evaluate the impact of a systematic postprescription review performed by antimicrobial stewardship program (ASP) infectious disease physicians (IDP) on the quality of in-hospital antibiotic use. A multicenter, prospective, randomized, parallel-group trial using the PROBE (Prospective Randomized Open-label Blinded Endpoint) methodology was conducted in eight surgical or medical wards of four hospitals. Two hundred forty-six patients receiving antibiotic therapy prescribed by ward physicians for less than 24 hours were randomized to receive either a systematic review by the ASP IDP at day 1 and days 3 to 4 (intervention group, n = 123) or no systematic review (usual care, n = 123). The primary outcome measure was appropriateness of antimicrobial therapy, a composite score of appropriateness of antibiotic use at days 3 to 4 and appropriate treatment duration, adjudicated by a blinded committee. Analyses were performed on an intention-to-treat basis. In the intervention group, appropriateness of antimicrobial therapy was more frequent (55/123, 44.7% vs. 35/123, 28.5%; odds ratio 2.03, 95% confidence interval 1.20-3.45). Antibiotic treatment duration was lower in the intervention group (median (interquartile range) 7 (3-9) days vs. 10 (7-12) days; p 0.003). ASP IDP counseling to change therapy was more frequent at days 3 to 4 than at day 1 (114/123; 92.7% vs. 24/123; 19.5%, p <0.001). Clinical outcome was similar between groups. This study suggests that a systematic postprescription antibiotic review performed at days 1 and 3 to 4 results in higher quality of antibiotic use and lower antibiotic duration. This trial was registered at ClinicalTrials.gov (NCT01136200).
authors: Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Université Paris EST Créteil, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.
authors: P
authors: P
authors: Lesprit
authors: Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Université Paris EST Créteil, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.
authors: A
authors: A
authors: de Pontfarcy
authors: Département d'Epidémiologie et Recherche Clinique, Hôpital Bichat, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, UMR 1123; and INSERM, CIC-EC 1425, Paris.
authors: M
authors: M
authors: Esposito-Farese
authors: Unité de Contrôle, Epidémiologie et Prévention de l'Infection, Université Paris EST Créteil, Groupe Hospitalier Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil.
authors: H
authors: H
authors: Ferrand
authors: Service de Microbiologie Clinique, Université Paris Descartes, Hôpital Européen Georges Pompidou.
authors: J L
authors: JL
authors: Mainardi
authors: Unité d'Intervention en Infectiologie, Service des Maladies Infectieuses et Tropicales, Université Paris 7-Denis Diderot, Hôpital Saint-Louis.
authors: M
authors: M
authors: Lafaurie
authors: Service de Microbiologie Clinique, Université Paris Descartes, Hôpital Européen Georges Pompidou.
authors: P
authors: P
authors: Parize
authors: Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale, Hôpital Bichat-Claude Bernard, AP-HP, Paris.
authors: C
authors: C
authors: Rioux
authors: Département d'Epidémiologie et Recherche Clinique, Hôpital Bichat, AP-HP; Université Paris Diderot, Sorbonne Paris Cité, UMR 1123; and INSERM, CIC-EC 1425, Paris.
authors: F
authors: F
authors: Tubach
authors: Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale, Hôpital Bichat-Claude Bernard, AP-HP, Paris; IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, France. Electronic address: p.lesprit@hopital-foch.org.
authors: J C
authors: JC
authors: Lucet
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic use; antimicrobial stewardship; hospital; infectious disease physician; review