Adult community-acquired pneumonia. Evaluation of the antibiotherapy proposed in an emergency department and analysis of the impact of training
Abstract number: 1134_03_121
Piglione L., Blanc V., Lerousseau L., Rafidiniaina D., Rotomondo C.
We evaluated the quality of adult community-acquired pneumonia (CAP) probabilist antibiotherapy within an Emergency Department and the influence of a targeted training on this prescription.
Study took place in a medium sized general hospital. All the files related to patients admitted for the diagnosis of CAP and hospitalized were reviewed in a prospective way by a local committee of independent Experts during the first half-year 2003 (T1) and the first half-year 2004 (T2), and compared. Between the two periods, the prescribing physicians have been trained (educational sessions based on the guidelines for pneumonia care of the French Society of Infectious Diseases (SPILF)). Three major quality indicators were used: initial molecule selection, dosage and time to first dose. Cost of antibiotherapy was calculated.
53 files were selected during T1 and 42 during T2. The 2 groups were well matched (age, sex, Fine's score). Inadequate initial molecule selection decreased from 43% to 29% (NS), inadequate dosage decreased from 4% to 0% (NS). Time to first dose was <4 hours in the 2 groups. Between T1 and T2, the prescription of amoxicillin increased by 15%, at the expense of fluoroquinolones (-13%) and of the 3rd-generation cephalosporins (-9%). Macrolides prescription remained stable. Antibiotherapy cost decreased by a 2.5 fold ratio (p < 0.05)
Our work demonstrates that, even if the dosage errors are rare and the antibiotic therapy is always early, there was a mediocre adhesion to the recommendations as regards to the choice of the molecule, before the intervention. Even though results obtained with our targeted training are modest, they are encouraging as they increased the use of guidelines recommended antibiotherapy, and leaded to significant cost gain. The development of different educational strategies is essential for the application of good medical practices for a better patient's management from the moment they are admitted in the Emergency Department.
|Session name:||XXIst ISTH Congress|
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