Pôle pharmacie, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
Service des maladies infectieuses et tropicales, CHU de Grenoble, CS 10217, 38043 Grenoble cedex 09, France.
Med Mal Infect. 2016 Mar;46(2):72-8. doi: 10.1016/j.medmal.2015.10.009. Epub 2016 Feb 10.
We aimed to evaluate carbapenem prescription compliance with guidelines for nosocomial and community-acquired infections.
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.
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.
These results highlight the need for a strong carbapenem stewardship program in our hospital.
评估碳青霉烯类药物在医院内和社区获得性感染中的应用是否符合指南规定。
我们在我院进行了一项为期四个月的前瞻性研究。纳入所有接受至少一剂碳青霉烯类药物治疗的成年和儿科住院患者。从患者的病历（纸质和电子数据；CristalLink 软件）中收集数据。两名传染病专家评估指南的符合情况。评估标准包括适应证、抗生素选择、剂量和治疗持续时间。
本研究共纳入 152 例患者（男性占 65.4%）。76.3%的处方符合碳青霉烯类药物的应用指征。经验性和有记录适应证处方中，分别有 73.9%和 77.8%的碳青霉烯类药物应用是恰当的。不符合指南的主要原因是用于治疗社区获得性感染。40.3%的患者无法开始降阶梯治疗，而在可以考虑降阶梯治疗的患者中，只有 51.7%开始降阶梯治疗。尽管平均治疗持续时间为 7.5 天，但仍有 23.7%的患者接受碳青霉烯类药物治疗超过 10 天。
这些结果突显了我们医院需要制定强有力的碳青霉烯类药物管理计划。
