title: Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections.
abstract: OBJECTIVE
  To analyse factors associated to "failure" in patients under antibiotic (AB) treatment at a third level hospital.
  
  
  METHODS
  All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as p<0.05.
  
  
  RESULTS
  602 of 1,265 admitted patients during the study month included an AB in their medical prescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to "failure" were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184).
  
  
  CONCLUSIONS
  A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment, being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Gómez-Gómez
authors.forename: Elisa
authors.initials: E
authors.lastname: García-Vázquez
authors.forename: Cristina
authors.initials: C
authors.lastname: Bonillo
authors.affiliation: Alicia Hernández-Torres, Service of Internal Medicine-Infectious Diseases, University Hospital Virgen de la Arrixaca. Ctra. Madrid-Cartagena - 30120 El Palmar (Murcia), Spain. aliciahernandeztorres@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Hernández-Torres
authors.forename: Manuel
authors.initials: M
authors.lastname: Canteras-Jordana
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000188:drug therapy*; D002985:Clinical Protocols; D003428:Cross Infection / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000639:trends; D057286:Electronic Health Records; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents