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Simplified therapeutic guidelines: the main tool of antimicrobial stewardship programs associated with optimal antibiotic therapy

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A Correction to this article was published on 29 January 2022

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Abstract

Hospitals regularly seek to upgrade their antimicrobial stewardship program (ASP). Our aim was to evaluate the impact of simplified therapeutic guidelines (STGs) compared to various established tools for ASP on the rate of optimal antibiotic therapy (OAT) and antibiotic consumption. Audits of antibiotic prescriptions were carried out over a 24-month period. Feedback information led to STGs (e.g., ≤ 15 drugs). The impact of STGs was based on the rate of OAT, defined as a diagnosis of the infectious disease in the patient’s medical records associated with the corresponding therapy indicated in the STGs or in other guidelines. STGs were compared to five other means of ASP: internal or national guidelines, audit, information regarding antibiotic consumption and bacterial resistance, and restricted access to targeted antibiotics. Antibiotic consumption was measured in defined daily doses/1000 days of hospital stay, focusing on third-generation cephalosporins (TGC) and fluoroquinolones (FQ). Twenty-six hospitals were audited from April 2017 to June 2019. A total of 1,028 antibiotic prescriptions were analyzed, including 204 (20%) after STG implementation in seven hospitals. In multivariate analysis, OAT (n = 176, 17%) was associated with STGs, AOR 2.21 [1.51–3.22], and with three tools in place, 1.75 [1.24–2.48]. The relative variations of consumption of TGC and FQ for hospitals with or without STGs were − 13.1 vs. + 9.4% and − 18.5 vs. − 2.7%, respectively, from 2018 to 2019. STGs were more likely than other ASP tools to improve the rate of OAT and to reduce the consumption of antibiotics.

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Data availability

The data used during the current study is available from the corresponding author on reasonable request.

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Funding

This study was carried out as part of our routine work.

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Authors and Affiliations

  1. Infectiologie, Clinique Les Fleurs, 332 Ave Frédéric Mistral, 83110, Ollioules, France

    Pierre-Marie Roger

  2. Faculté de Médecine, Campus de Fouillole, Université Des Antilles, Pointe-à-Pitre, Guadeloupe, France

    Pierre-Marie Roger

  3. Clinique Les Fleurs, Ave Frédéric Mistral, Ollioules, 83190, France

    Pierre-Marie Roger

  4. Clinique St Augustin, 114, Ave d’Ares, 33074, Bordeaux, France

    Anne Espinet

  5. Clinique de l’Orangerie, 29, Allée de la Robertsau, 67000, Strasbourg, France

    Delphine Ravily

  6. Hôpital Privé Guillaume de Varye, 210 Rte de Vouzeron, 18230, St Doulchard, France

    Marie-José Meyer

  7. Recherche Clinique, Clinique du Cap d’Or, 1361 Avenue des Anciens Combattants Français, 83500, La Seyne-sur-Mer, France

    Francine Moll

  8. Clinique St Roch, Rue Ambroise Croizat, 66330, Cabestany, France

    Eve Montera

  9. Clinique Médicale Et Cardiologique, Rue de Lourdes, 64320, Aressy, France

    Agnès Rancezot

  10. Clinique du Sidobre, Chemin de St Hippolyte, 81100, Castres, France

    Véronique Dautezac

  11. Clinique St Pierre, 169 Ave de Prades, 66000, Perpignan, France

    Olivier Pantaloni

Authors
  1. Pierre-Marie Roger
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  2. Anne Espinet
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  3. Delphine Ravily
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  4. Marie-José Meyer
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  5. Francine Moll
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  7. Agnès Rancezot
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  8. Véronique Dautezac
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  9. Olivier Pantaloni
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Contributions

P-M. R, V. D., and A. R. contributed to the study design. P-M. R. and F. M. contributed to the statistical analysis; E. M., P-M. R., A. R., and V. D. contributed to the writing of the article; P-M. R., D. R., O. P., and M-J. M. contributed to the study design and patient inclusion.

Corresponding author

Correspondence to Pierre-Marie Roger.

Ethics declarations

Ethics approval

The antibiotic audit was sponsored by the French National Health Agency.

Consent to participate

The patients or their relatives provided written consent for computerization of their personal data for hospitalization purposes and clinical research. In accordance with national directives, patient privacy was protected as no personal data were extracted or copied from the computerized chart.

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All authors have read the paper and consent to its publication.

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The authors declare no competing interests.

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The original online version of this article was revised: “V3” was incorrectly added at the end of the main title of the originally published article.

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Roger, PM., Espinet, A., Ravily, D. et al. Simplified therapeutic guidelines: the main tool of antimicrobial stewardship programs associated with optimal antibiotic therapy. Eur J Clin Microbiol Infect Dis 41, 375–383 (2022). https://doi.org/10.1007/s10096-021-04317-z

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  • DOI: https://doi.org/10.1007/s10096-021-04317-z

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