Anti-infectious treatment duration: The SPILF and GPIP French guidelines and recommendations

Gauzit, R.; Castán, B.; Bonnet, É.; Bru, J.P.; Cohen, Robert; Diamantis, S.; Faye, Albert; Hitoto, H.; Issa, N.; Lebeaux, David; Lesprit, Philippe; Maulin, Laurence; Poitrenaud, Delphine; Raymond, J.; Strady, C.; Varon, Emmanuelle; Verdon, Renaud; Vuotto, Fanny; Welker, Yves; Stahl, J.P.

doi:10.1016/j.idnow.2020.12.001

Cited by 28 publications

(15 citation statements)

References 113 publications

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“…These results are consistent with clinical practice. Indeed, antibiotic therapy for community-acquired and nosocomial pneumonia is well de ned by current recommendations [4,5,8,9,21], which allows physicians to better comply with recommendations. This compliance can nevertheless still be improved for late-onset VAP and for nosocomial pneumonia without mechanical ventilation, which were, in our study, independent risk factors of non-compliance for antimicrobials' choice and reassessment at 72 hours.…”

Section: Discussionmentioning

confidence: 99%

“…Catheter infections are frequently suspected in ICU. The management of these infections is well de ned and the absence of documentation (bacteriological samples before starting antibiotic therapy) should lead to discontinuation of antibiotic therapy at 48-72 hours [5]. Finally, a presence of ≥ 1 risk factor for ESBL Enterobacteriaceae also increased risk of non-compliance for the choice of antimicrobials.…”

Section: Discussionmentioning

confidence: 99%

“…Standard-of-care of antibiotic treatment and duration is determined by the type of infection, microbiological results, and clinical and biological evolution, according to published guidelines. These recommendations are numerous: French (SPILF, GPIP, SFAR, SRLF, HAS) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20],…”

Section: Introductionmentioning

confidence: 99%

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Compliance with antibiotic therapy guidelines in French pediatric intensive care units (COMITY study)

Amadieu¹,

Bréhin²,

Chahine³

et al. 2023

Preprint

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Background: Bacterial infections (BIs) are widespread in ICU. The aims of this study were to assess the compliance with antibiotic recommendations, and factors associated with non-compliance. Methods: We conducted an observational study in eight French Pediatric and Neonatal ICUs with an antimicrobial stewardship program mostly once a week. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns <72 hours old, neonates <37 weeks, age ≥18 years, and antibiotic for prophylaxis were excluded. Results: 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% no bacterial infection, 40.3% presumed bacterial infection, and 35.3% documented bacterial infection. Non-compliance for all parameters occurred in 51.1%, with errors mainly concerning the antimicrobials’ choice (27.3%), duration of each antimicrobial (26.3%), and duration of antibiotic therapy (18.0%). In multivariate analysis, main independent risk factors of non-compliance were prescribing ≥2 antibiotics (OR 4.06, 95% CI 1.69-9.74, p=0.0017), a duration of broad-spectrum antibiotic therapy ≥4 days (OR 2.59, 95% CI 1.16-5.78, p=0.0199), suspecting catheter-related bacteremia (ORs 3.70 and 5.42, 95% CIs 1.32 to 15.07, p<0.02), a BI site with no clear treatment guidelines (ORs 3.29 and 15.88, 95% CIs 1.16 to 104.76, p<0.03), and ≥1 risk factor for ESBL Enterobacteriaceae (OR 2.56, 95% CI 1.07-6.14, p=0.0353). Main independent factors of compliance were having antibiotic therapy protocols (OR 0.42, 95% CI 0.19-0.92, p=0.0313), respiratory failure (OR 0.36, 95% CI 0.14-0.90, p=0.0281), and aspiration pneumonia (OR 0.37, 95% CI 0.14-0.99, p=0.0486). Conclusions: Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should daily reassess the benefit of using several or broad-spectrum antimicrobials and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using service protocols seem necessary to reduce errors. A daily ASP could also improve compliance in these error-prone situations. Trial registration: This trial was approved by Toulouse University Hospital, and is registered in its register of data study, number RnIPH2019-79, and with ClinicalTrials.gov, number NCT04642560. The date of first trial registration in ClinicalTrials.gov was 24/11/2020.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Compliance with antibiotic therapy guidelines in French pediatric intensive care units (COMITY study)

Amadieu¹,

Bréhin²,

Chahine³

et al. 2023

Preprint

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“…Antibiotics have been produced specifically to treat infections caused by highly resistant bacteria, but the absolute number of infections caused by highly resistant bacteria is relatively low in countries able to purchase these new antibiotics. As soon as the new broad-spectrum antibiotics become available, antibiotics stewardship policies will restrict the prescription of these molecules: firstly, by limiting prescriptions to documented infections with highly resistant bacteria [ 7 ] and, secondly, by promoting short treatment durations [ 28 , 32 ].…”

Section: Introduction and Literature Reviewmentioning

confidence: 99%

The Production of Antibiotics Must Be Reoriented: Repositioning Old Narrow-Spectrum Antibiotics, Developing New Microbiome-Sparing Antibiotics

Diamantis

Retur

Bertrand³

et al. 2022

Antibiotics

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The development of broad-spectrum antibiotics to control multidrug-resistant bacteria is an outdated business model. This strategy has led to the introduction of highly effective antibiotics, but their widespread use has contributed to the emergence of even broader antibiotic resistance. In a strategy to combat antimicrobial resistance, we believe that the use of narrow-spectrum antibiotics should be promoted. This should involve both the repositioning of old antibiotics and the reorientation of research and development towards new narrow-spectrum antibiotics with a low ecological impact. These antibiotics could be prescribed for common conditions such as sore throats and cystitis, which account for the bulk of antibiotic use in humans. Narrow-spectrum, targeted, microbiome-sparing antibiotics could help control antibiotic resistance while being economically sustainable. Their development and production should be supported by governments, which would ultimately benefit from reduced health care costs.

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“…The most recent studies have shown that a shorter duration of antibiotics improves the above parameters, without limiting the treatment of the infection [ 13 ]. These results explain why the duration of the antibiotics to treat a simple acute cystitis is 3 days, and no longer 5 days, with pivmecillinam, or with a single dose of fosfomycin trometamol [ 9 , 14 ]. To reduce the antimicrobial resistance (AMR), the nature of the antibiotic must be considered, and guidelines must be reviewed regularly [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies

et al. 2022

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Urinary tract infections, especially cystitis, are common infections; they are the second most prevalent cause of antibiotic prescriptions in community pharmacies. To reduce antimicrobial resistance, guidelines are revised regularly. This study aims to assess compliance between prescriptions collected in community pharmacies and French cystitis guidelines. A treatment is considered compliant if the nature, dosage, and duration of the antibiotics are correct. Only women aged 18–65 years with a diagnosis of cystitis were eligible. The participation of 16 pharmacies resulted in 303 prescriptions. Most infections were classified as uncomplicated cystitis (79.2%), general practitioners were the prescribers in more than 9 out of 10 cases, and fosfomycin trometamol was the antibiotic dispensed for 1 in 2 women. An average compliance of 66% was observed, but with disparities according to the type of cystitis. Two-thirds of cases of uncomplicated cystitis and recurrent cystitis followed the recommendations, whereas only 15% of cystitis cases that were at risk of complication did so. The inclusion of a urine examination in uncomplicated cystitis decreased the overall compliance rate to 5.8%. These results show the essential role played by pharmacists; they are the last line of defence before dispensing antibiotics. They must know the recommendations in order to apply them.

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Anti-infectious treatment duration: The SPILF and GPIP French guidelines and recommendations

Cited by 28 publications

References 113 publications

Compliance with antibiotic therapy guidelines in French pediatric intensive care units (COMITY study)

Compliance with antibiotic therapy guidelines in French pediatric intensive care units (COMITY study)

The Production of Antibiotics Must Be Reoriented: Repositioning Old Narrow-Spectrum Antibiotics, Developing New Microbiome-Sparing Antibiotics

Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies

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