Decreasing mortality in severe sepsis and septic shock patients by implementing a sepsis…

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Apparent temperature and cause-specific emergency hospital admissions in Greater Copenha…

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New tools for systematic evaluation of teaching qualities of medical faculty: results of…

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To compare PubMed Clinical Queries and UpToDate in teaching information mastery to clini…

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Seasonal and temperature-associated increases in gram-negative bacterial bloodstream inf…

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Methicillin-resistant Staphylococcus aureus infection and hospitalization in high-risk p…

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Predicting hospital-acquired infections by scoring system with simple parameters.
…

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Methicillin-resistant Staphylococcus aureus nasal colonization among adult patients visi…

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Central line bundle implementation in US intensive care units and impact on bloodstream infections.
PLoS One. 2011;6(1):e15452
Authors: Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW
Central li…

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Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

PLoS One. 2010;5(11):e14011

Authors: Cusini A, Rampini SK, Bansal V, Ledergerber B, Kuster SP, Ruef C, Weber R

BACKGROUND: Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription. METHODOLOGY/PRINCIPAL FINDINGS: Experienced infectious diseases (ID) fellows performed audits of antimicrobial use at regular intervals among all patients-with or without antimicrobials-hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4%) had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4%) prescriptions were for therapy and 312 (24.6%) for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%); incorrect choice of antimicrobials (7.6%); incorrect application of drugs (9.3%); and divergence from institutional guidelines (8%). Characteristics of inappropriate prophylaxes were: No indication (9%); incorrect choice of antimicrobials (1%); duration too long or other inappropriate use (6.7%). Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results. CONCLUSIONS/SIGNIFICANCE: Audits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial prescriptions without indication, and divergence from institutional guidelines were frequent errors. Based on these results, we will tailor education, amend institutional guidelines and further develop the infectious diseases consultation service.

PMID: 21103362 [PubMed - in process]

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Related Articles

Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes.

PLoS ONE. 2009;4(2):e4439

Authors: Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M

Adverse drug reactions (ADRs) are a major cause of hospital admissions, but recent data on the incidence and clinical characteristics of ADRs which occur following hospital admission, are lacking. Patients admitted to twelve wards over a six-month period in 2005 were assessed for ADRs throughout their admission. Suspected ADRs were recorded and analysed for causality, severity and avoidability and whether they increased the length of stay. Multivariable analysis was undertaken to identify the risk factors for ADRs. The 5% significance level was used when assessing factors for inclusion in multivariable models. Out of the 3695 patient episodes assessed for ADRs, 545 (14.7%, 95% CI 13.6-15.9%) experienced one or more ADRs. Half of ADRs were definitely or possibly avoidable. The patients experiencing ADRs were more likely to be older, female, taking a larger number of medicines, and had a longer length of stay than those without ADRs. However, the only significant predictor of ADRs, from the multivariable analysis of a representative sample of patients, was the number of medicines taken by the patient with each additional medication multiplying the hazard of an ADR episode by 1.14 (95% CI 1.09, 1.20). ADRs directly increased length of stay in 147 (26.8%) patients. The drugs most frequently associated with ADRs were diuretics, opioid analgesics, and anticoagulants. In conclusion, approximately one in seven hospital in-patients experience an ADR, which is a significant cause of morbidity, increasing the length of stay of patients by an average of 0.25 days/patient admission episode. The overall burden of ADRs on hospitals is high, and effective intervention strategies are urgently needed to reduce this burden.

PMID: 19209224 [PubMed - indexed for MEDLINE]

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