Martinez J-S, Le Falher G, Corne P, Bourdin A, Lequellec A, Delabre J-P, Makinson A, Hansel S, Reynes J, Le Moing V
Service des maladies infectieuses et tropicales, hôpital Gui-de-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
Med Mal Infect. 2010 Aug;40(8):468-75. doi: 10.1016/j.medmal.2010.01.009. Epub 2010 Feb 18.
The authors had for aim to assess the conformity of antibiotic prescription with guidelines, for the management of community-acquired pneumonia, in a French University Hospital.
This prospective study included adults patients hospitalized for pneumonia over a period of six months. The attending physician estimated the severity of pneumonia. The adequacy to guidelines focused on: first antibiotic choice and prescription modality, antibiotic choice in case of treatment modification at 48 to 72 hours, and duration of antibiotherapy.
A hundred and nine cases of pneumonia were included in 106 patients. The mean age was 66 years, the mortality rate was 17 %. Bacterial documentation was recorded in 40.4 % of cases. The first antibiotics used were in accordance with guidelines in 52.3 % of cases. The non conformity rate was minor in 55.8 % of cases. Antibiotherapies putting the patient at risk were used in less than 10 % of the cases. The rate of antibiotic modification at 48 to 72 hours was 46.8 %, primarily for bacteriological purposes (35.3 %) or initial treatment failure (27.4 %). The treatment duration was inappropriate in 52.7 % of cases and generally too long in case of non conformity.
It seems important to support guideline information, training of prescribers, and to consult an antibiotic expert.
作者旨在评估法国一家大学医院中社区获得性肺炎管理方面抗生素处方与指南的符合情况。
这项前瞻性研究纳入了在六个月期间因肺炎住院的成年患者。主治医生评估肺炎的严重程度。对指南的符合情况重点关注：初始抗生素选择和处方方式、48至72小时治疗调整时的抗生素选择以及抗菌治疗的持续时间。
106例患者中纳入了109例肺炎病例。平均年龄为66岁，死亡率为17%。40.4%的病例记录了细菌学证据。52.3%的病例中使用的初始抗生素符合指南。55.8%的病例中不符合率较低。不到10%的病例使用了使患者有风险的抗菌治疗。48至72小时抗生素调整率为46.8%，主要是出于细菌学目的（35.3%）或初始治疗失败（27.4%）。52.7%的病例治疗持续时间不合适，不符合时通常过长。
支持指南信息、培训开处方者并咨询抗生素专家似乎很重要。
