Afekouh Hind, Baune Patricia, De Falvelly Diane, Guermah Fatima, Ghitri Saïda, Haber Nicole
Département de médecine gériatrique, Hôpital Charles Richet, AP-HP, Villiers le Bel, France.
Équipe opérationnelle d'hygiène, Hôpital Charles Richet, AP-HP, Villiers le Bel, France, Équipe opérationnelle d'hygiène, Hôpital Paul Brousse, AP-HP, Villejuif, France.
Geriatr Psychol Neuropsychiatr Vieil. 2017 Mar 1;15(1):47-54. doi: 10.1684/pnv.2017.0658.
Prescription of antibiotic in elderly patients must follow guidelines. to study the quality of antibiotic prescriptions for urinary tract infections (UTI) in the geriatric rehabilitation unit. Over a four-month period, all the antibiotics treatments prescribed for UTI in the rehabilitation ward were analyzed prospectively by medical experts and confronted with the recommendations of the local antibiotic guidelines. The methodology was based on Gyssens' algorithm. Treatments were considered appropriate if indication, choice of the molecule, duration and dose were approved by the experts, unnecessary if the indication was incorrect, and inappropriate in all other cases. The re-assessment of the prescription between 48 and 72 h was also evaluated. We reviewed 39 prescriptions. About half of all prescriptions (51.3%) was found to be unnecessary due to misdiagnosis, 16 prescriptions (41%) were considered inappropriate (2 for inadequate duration and 14 for inappropriate spectrum of activity, mainly with ceftriaxone prescriptions (9 cases)). Ten prescriptions (25.6%) were re-assessed between 48 and 72 hours after treatment initiation. According to this study, an improvement program was implemented. A diagnostic algorithm for UTI in elderly was drafted and will be integrated into the local guidelines. A supporting document for the re-assessment of the prescriptions 48-72h after treatment initiation was created. We decided to perform an evaluation of antibiotic prescriptions by the subcutaneous route.
老年患者使用抗生素必须遵循指南。为研究老年康复病房中尿路感染（UTI）抗生素处方的质量，在四个月的时间里，医学专家对康复病房中所有因UTI开具的抗生素治疗进行了前瞻性分析，并与当地抗生素指南的建议进行对照。该方法基于吉森算法。如果适应证、药物选择、疗程和剂量得到专家认可，则治疗被认为是恰当的；如果适应证不正确，则认为是不必要的；在所有其他情况下则认为是不恰当的。还评估了在48至72小时之间对处方的重新评估情况。我们审查了39份处方。由于误诊，约一半的处方（51.3%）被认为是不必要的，16份处方（41%）被认为是不恰当的（2份疗程不足，14份活性谱不恰当，主要是头孢曲松处方（9例））。10份处方（25.6%）在开始治疗后48至72小时之间进行了重新评估。根据这项研究，实施了一项改进计划。起草了一份老年UTI诊断算法，并将其纳入当地指南。创建了一份在治疗开始后48 - 72小时对处方进行重新评估的支持文件。我们决定对皮下途径使用抗生素的处方进行评估。
