title: Antibiotic prescription evaluation in the rehabilitation ward of a geriatric hospital.
abstract: OBJECTIVE
  We aimed to identify the indications for antibiotic prescriptions made to patients hospitalized in the rehabilitation ward of a geriatric hospital. Our final objective was to assess those prescriptions.
  
  
  METHODS
  Medical experts performed a prospective study of all antibiotic treatments prescribed in the rehabilitation ward over a 4-month period based on Gyssens' algorithm and on the local guidelines for anti-infective drugs. Treatments were considered appropriate when the indication, choice of agent, duration, and dose were approved by the experts. They were however considered unnecessary when the indication was incorrect, and they were deemed inappropriate when the experts approved the indication but considered that treatment modalities were not optimal. We also reviewed the prescription re-evaluation made 48 to 72hours after treatment initiation.
  
  
  RESULTS
  We reviewed 142 prescriptions. Treatments had mainly been prescribed for respiratory tract infections (81 infections), urinary tract infections (41), skin infections (15), or abdominal infections (8). A total of 27 prescriptions (19%) were considered unnecessary mainly because a urinary tract infection diagnosis had been wrongly made (21 prescriptions). Half of the prescriptions were considered inappropriate: 38 prescriptions had an inappropriate spectrum of activity and 32 had an inadequate treatment duration. A total of 67 prescriptions (47.2%) had been reassessed 48-72hours after treatment initiation. Overall, 25 prescriptions (17.6%) were considered appropriate and were reassessed 48-72hours after treatment initiation.
  
  
  CONCLUSIONS
  We now have a better understanding of antibiotic prescription in a rehabilitation ward context. We identified several points that need to be improved: update and improvement of the local guidelines, better training for prescribers, and creation of a supporting document for the reassessment of the prescriptions 48-72hours after treatment initiation.
authors.affiliation: Département de Médecine Gériatrique, Hôpital Charles Richet, Assistance Publique-Hôpitaux de Paris, rue Charles Richet, 95400 Villiers-le-Bel, France.
authors.forename: H
authors.initials: H
authors.lastname: Afekouh
authors.affiliation: Équipe opérationnelle d'hygiène, Hôpital Charles Richet, Assistance Publique-Hôpitaux de Paris, 95400 Villiers-le-Bel, France.
authors.forename: P
authors.initials: P
authors.lastname: Baune
authors.affiliation: CIC-EC 1425, Département d'épidémiologie et recherche clinique, Groupe Hospitalier Paris Nord Val-de-Seine, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, 75018 Paris, France; UMR 1123 ECEVE, Université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France; INSERM, U1123, CIC-EC 1425, 75019 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Abbas
authors.affiliation: Pharmacie, Hôpital Charles Richet, Assistance Publique-Hôpitaux de Paris, 95400 Villiers-le-Bel, France.
authors.forename: D
authors.initials: D
authors.lastname: De Falvelly
authors.affiliation: Département de Médecine Gériatrique, Hôpital Charles Richet, Assistance Publique-Hôpitaux de Paris, rue Charles Richet, 95400 Villiers-le-Bel, France.
authors.forename: F
authors.initials: F
authors.lastname: Guermah
authors.affiliation: Département de Médecine Gériatrique, Hôpital Charles Richet, Assistance Publique-Hôpitaux de Paris, rue Charles Richet, 95400 Villiers-le-Bel, France. Electronic address: nicole.haber@aphp.fr.
authors.forename: N
authors.initials: N
authors.lastname: Haber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005853:Geriatrics; D006757:Hospital Units; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012046:Rehabilitation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Antibiotiques; Geriatrics; Gériatrie; Rehabilitation ward; Soins de suite et réadaptation