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Unsolicited post-prescription antibiotic review in surgical and medical wards: factors associated with counselling and physicians’ compliance

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The purpose of this investigation was to describe the impact of an early review of antibiotic prescriptions in a hospital using unsolicited infectious disease physician (IDP) counselling, identify areas for improvement and examine factors associated with physicians’ non-compliance. The prescriptions of 15 selected antibiotics from surgical or medical wards were screened daily and reviewed between days 3 and 5 by a single IDP during an 8-month period to identify those likely needing counselling. Improved antibiotic use was sought by encouraging ward physicians to withdraw or de-escalate therapy, promoting oral switch or reducing the duration of therapy whenever appropriate. Variables potentially associated with IDP counselling and physicians’ non-compliance were tested using bivariate analysis and then entered in a logistic regression model. Among 857 prescriptions analysed, 54.6 % prompted unsolicited counselling, mostly for stopping therapy (18.8 %), reducing its duration (18.0 %) or de-escalation (13.0 %). Variables independently associated with IDP counselling included antibiotic combination (adjusted odds ratio [aOR], 5.27 [95 % confidence interval (CI), 1.80–15.45]; p = 0.002), non-clinically documented infection (aOR, 4.98 [95 % CI, 2.81–8.82]; p < 0.001) and microbiologically documented infection (aOR, 2.04 [95 % CI, 1.51–2.75]; p < 0.001). The physicians’ compliance rate was 77.3 %. Variables independently associated with physicians’ non-compliance to the IDP recommendation were the surgical speciality of the ward physician (aOR, 1.91 [95 % CI, 1.17–3.12]; p = 0.009) and advice to reduce the duration of therapy (aOR, 1.88 [95 % CI, 1.12–3.15]; p = 0.017). An unsolicited post-prescription antibiotic review can be successfully implemented with a high rate of physicians’ compliance. Areas for targeting improvement measures include prescriptions in surgical wards and shortening the duration of therapy.

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  1. Unité de Contrôle, Epidémiologie et Prévention de l’Infection, Assistance Publique—Hôpitaux de Paris, Hôpital Henri Mondor, Université Paris 12, Créteil, France

    P. Lesprit, C. Landelle & C. Brun-Buisson

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  1. P. Lesprit
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  2. C. Landelle
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  3. C. Brun-Buisson
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Correspondence to P. Lesprit.

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Lesprit, P., Landelle, C. & Brun-Buisson, C. Unsolicited post-prescription antibiotic review in surgical and medical wards: factors associated with counselling and physicians’ compliance. Eur J Clin Microbiol Infect Dis 32, 227–235 (2013). https://doi.org/10.1007/s10096-012-1734-3

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  • DOI: https://doi.org/10.1007/s10096-012-1734-3

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