Background Carbapenems (CBPs) are being used more and more because of the increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Due to the extensive misuse of these antibiotics, some bacteria have developed CBP-resistant mutations. This epidemiological situation should make us wonder about prescribing CBPs. Purpose To describe prescribing patterns of imipenem/cilastatin, ertapenem and meropenem in elderly inpatients: context and impact of an interdisciplinary approach to prescriptions analysis. Materials and MethodsA retrospective study of CBP prescriptions was performed over a ten-month period (March-December 2011) in geriatric departments (313 beds). Data were collected from the electronic medical records, bacteriological analysis results and email exchanges between the infectious diseases physician (IDP), bacteriologists and pharmacists (prescription monitoring system). The following items were noted: patients, prescriptions and bacteriological characteristics. Results 55 patients were included with a total of 61 CBP prescriptions. The mean age was 83 (sex ratio 0.72). 71% of patients accumulated between 2 and 5 risk factors of multidrug resistant bacteria. Imipenem was the most-used carbapenem (n = 35; 57%) compared to ertapenem (n = 23; 38%) and meropenem (n = 3; 5%). Major indications were urinary tract infections (n = 37; 61%) and pneumonia (n = 15; 25%). 59% of infections were nosocomial. 39% of CBP prescriptions were written after a first-line antibiotic had failed (ceftriaxone most of the time). The overall duration of carbapenem therapy was 11 days. Microbiologically-documented infections and ESBL bacteria accounted for 69% (n = 42) and 51% (n = 24) of prescriptions, respectively: 5 of the ESBL strains isolated were community-acquired bacteria. 61% (n = 38) of prescriptions were reassessed by an IDP: 29 (76%) were in accordance with recommendations; 7 (18%) were stopped or changed for a narrow-spectrum antibiotic. Conclusions CBP prescriptions seem relatively well controlled in geriatric care units due to multidisciplinary analysis of the prescriptions. Nevertheless, evaluation of the impact of monitoring prescriptions for use of CBPs requires longer follow-up. No conflict of interest.
Background Overuse of antibiotics, such as fluoroquinolones and third-generation cephalosporins, is a major cause of the emergence of extended-spectrum beta lactamase producing enterobacteriaceae. The use of levofloxacin in elderly inpatients is widespread. Purpose We investigated the conditions in which this drug was prescribed. Materials and Methods From 1st January to 31st March 2012, information was recorded on every new levofloxacin prescription from the geriatric units: indication, dose, duration, patient’s medical history, renal function and previous antibiotic. In parallel, levofloxacin consumption was assessed and expressed in terms of the number of Defined Daily Doses (DDD) per 1000 patient-days (PD). The consumption was compared with the data from the French antibiotic network “RAISIN”. Results 87 patients had a levofloxacin prescription: 55% for community-acquired pneumonia, 20% for nursing-associated pneumonia, 16% for nosocomial pneumonia, and 9% for others indications. 77% of the patients had previously received another antibiotic (47 amoxicillin/clavulanic acid, 20 ceftriaxone). Among patients without signs of gravity (tachycardia, tachypnea, hypotension), 1 in every 2 received levofloxacin associated with ceftriaxone, although this combination is only for intensive care patients according to the French Society of Infectious Diseases. The mean duration of treatment was 10 days. In 1 in every 2 cases, dosage was too high according to the renal function. As a result, the exposure to levofloxacin was 49 DDD per 1000 PD in acute-care units, and 37 DDD per 1000 PD in skilled units. These results are 4 to 7 times higher than those recorded in the “RAISIN” network. For 20% of the patients, levofloxacin was ineffective and another line of antibiotic was prescribed. Conclusions Our results suggest that to reduce exposure to fluoroquinolones we should avoid systematic association with ceftriaxone, prescribe levofloxacin as the second line after amoxicillin/clavulanic acid and reduce dose and duration. No conflict of interest.
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