title: Compliance with carbapenem guidelines in a university hospital.
abstract: OBJECTIVE
  We aimed to evaluate carbapenem prescription compliance with guidelines for nosocomial and community-acquired infections.
  
  
  METHODS
  We conducted a prospective study over a four-month period at our university hospital. We included all adult and pediatric hospitalized patients who had received at least one dose of carbapenem. Data was collected from patients' medical records (hard copy and computerized data; CristalLink software). Compliance with guidelines was assessed by two infectious disease specialists. Assessment criteria included indication, antibiotic choice, dosage, and treatment duration.
  
  
  RESULTS
  We included 152 patients in the study (65.4% of men). Carbapenem prescription was appropriate for 76.3% of prescriptions. The use of carbapenems was considered appropriate for 73.9% of empirical prescriptions and for 77.8% of documented prescriptions. Non-compliance with guidelines was mainly due to prescriptions for community-acquired infections. Antibiotic de-escalation could not be initiated in 40.3% of patients and was only initiated in 51.7% of patients for whom it could be considered. Although the average treatment duration was 7.5 days, 23.7% of patients received carbapenems for more than 10 days.
  
  
  CONCLUSIONS
  These results highlight the need for a strong carbapenem stewardship program in our hospital.
authors.affiliation: Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Van Hollebeke
authors.affiliation: Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
authors.forename: C
authors.initials: C
authors.lastname: Chapuis
authors.affiliation: Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
authors.forename: S
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
authors.forename: L
authors.initials: L
authors.lastname: Foroni
authors.affiliation: Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Stahl
authors.affiliation: Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
authors.forename: P
authors.initials: P
authors.lastname: Bedouch
authors.affiliation: Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France. Electronic address: ppavese@chu-grenoble.fr.
authors.forename: P
authors.initials: P
authors.lastname: Pavese
mesh_terms: D001424:Bacterial Infections / Q000188:drug therapy*; D015780:Carbapenems / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015780:Carbapenems
keywords: Carbapenemases; Carbapenems; Carbapénèmases; Carbapénèmes; Entérobactéries productrices de bêta-lactamases à spectre étendu; Extended-spectrum beta-lactamase-producing Enterobacteriaceae