title: Implementation of a simple innovative system for postprescription antibiotic review based on computerized tools with shared access.
abstract: BACKGROUND
  Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance.
  
  
  OBJECTIVE
  To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital.
  
  
  METHODS
  An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum β-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions. The data [patient, antibiotic(s), prescription start date, etc.] were registered on an AMT spreadsheet with shared access, where the microbiologist's opinion on the drug choice, based on available microbiology results, was entered. When the microbiologist and pharmacist did not approve the antibiotic prescribed, a same-day alert was generated and sent to the IDS. That alert led the IDS to re-evaluate the treatment.
  
  
  RESULTS
  From 2012 to 2014, 2106 targeted antibiotic prescriptions were reviewed. Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the IDS. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was <30 min/day for each AMT member. This system allowed correct use of targeted antibiotics for 91.8% of prescriptions, but had no significant impact on targeted antibiotic consumption.
  
  
  CONCLUSIONS
  This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limited misuse of broad-spectrum antibiotics.
authors.affiliation: Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France. Electronic address: frederique.bouchand@aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: A
authors.initials: A
authors.lastname: Dinh
authors.affiliation: Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: A L
authors.initials: AL
authors.lastname: Roux
authors.affiliation: Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Davido
authors.affiliation: Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: H
authors.initials: H
authors.lastname: Michelon
authors.affiliation: Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: M
authors.initials: M
authors.lastname: Lepainteur
authors.affiliation: Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Legendre
authors.affiliation: Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: El Sayed
authors.affiliation: Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: I
authors.initials: I
authors.lastname: Pierre
authors.affiliation: Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: J
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Perronne
authors.affiliation: Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: M
authors.initials: M
authors.lastname: Villart
authors.affiliation: Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France.
authors.forename: A-C
authors.initials: AC
authors.lastname: Crémieux
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D001330:Electronic Data Processing; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D050316:Medical Order Entry Systems
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial review; Computerized alert; Hospital; Infectious disease specialist; Pharmacist