Good anti-infectives use: evolution of pharmaceutical interventions in two years at the Hospital center of Seclin

摘要

Abstract. In our institution (375 hospitalization beds and 275 beds of EHPAD and USLD), control actions and promoting of the good anti-infective use are conducted by the mobile team consisting of a microbiologist, clinician's referents antibiotics, pharmacists, and since the end of 2010, an infectious disease specialist. The objective of this study is to analyze and evaluate IP changes with the arrival of this specialist and the development of pharmaceutical validation of computerized prescriptions. A prospective study is conducted comparing the PI on the anti-infectives prescriptions controlled dispensation of all services over a period of 9 weeks in 2010 and 2012. 99 PI in 2010 are found for 458 anti-infectives supported (22%) vs 165 PI for 569 anti-infectives supported (29%) in 2012: the proportion of PI is statistically higher in 2012 [p<0.005, a=0.05]. The majority of PI are secondary to non-compliance with consensus: no revaluation treatment (12.7% in 2012 vs. 9.9% in 2010), misuse and lack of monitoring of aminoglycosides (10.9 % in 2012 vs. 9% in 2010), a recent practice of urologists using cefixime in the treatment of prostatitis (2.4% in 2012), misuse of the association ceftriaxone/levofloxacin (11% in 2012) in non-severe respiratory infections... The acceptance rate by prescribers is not significantly higher in 2012 than in 2010 (61% in 2012 vs. 56% in 2010) [p<0.7, alpha=0.05]. A focus on the comparison of the PI of the computerized and not computerized departments of 2012 is added. Controlled working axes are objectified (restriction use of fluoroquinolones, treatment of infections SAMS), corrective actions are to be pursued (revaluation treatments at 48-72h, aminoglycosides good use) and new actions need to be taken (with emergency work on removing levofloxacin associated to ceftriaxone in non-severe respiratory infections, addition of cefixime in controlled dispensation, establishment of a shared file for bacteremia follow-up). Collaboration pharmacy/infectious disease specialist is the cause of multidisciplinary discussions and relevance of improved IP around priorities.