Open Access Highly Accessed Research article

Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study

Julian Mettler1, Mathew Simcock12, Pedram Sendi12, Andreas F Widmer1, Roland Bingisser3, Manuel Battegay1, Ursula Fluckiger1 and Stefano Bassetti14*

Author Affiliations

1 Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, CH – 4031 Basel, Switzerland

2 Basel Institute for Clinical Epidemiology, University Hospital Basel, CH – 4031 Basel, Switzerland

3 Emergency Department, University Hospital Basel, CH – 4031 Basel, Switzerland

4 Department of Internal Medicine, Kantonsspital Olten, Baslerstrasse 150, CH – 4600 Olten, Switzerland

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BMC Infectious Diseases 2007, 7:21  doi:10.1186/1471-2334-7-21

Published: 26 March 2007

Abstract

Background

Several strategies to optimise the use of antibiotics have been developed. Most of these interventions can be classified as educational or restrictive. Restrictive measures are considered to be more effective, but the enforcement of these measures may be difficult and lead to conflicts with prescribers. Any intervention should be aimed at targets with the highest impact on antibiotic prescribing. The aim of the present study was to assess the adequacy of empirical and adjusted antibiotic therapies in a Swiss university hospital where no antibiotic use restrictions are enforced, and to identify risk factors for inadequate treatment and targets for intervention.

Methods

A prospective observational study was performed during 9 months. All patients admitted through the emergency department who received an antibiotic therapy within 24 hours of admission were included. Data on demographic characteristics, diagnoses, comorbidities, systemic inflammatory response syndrome (SIRS) parameters, microbiological tests, and administered antibiotics were collected prospectively. Antibiotic therapy was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to local recommendations or published guidelines.

Results

2943 admitted patients were evaluated. Of these, 572 (19.4%) received antibiotics within 24 hours and 539 (94%) were analysed in detail. Empirical antibiotic therapy was inadequate in 121 patients (22%). Initial therapy was adjusted in 168 patients (31%). This adjusted antibiotic therapy was inadequate in 46 patients (27%). The main reason for inadequacy was the use of antibiotics with unnecessarily broad spectrum (24% of inadequate empirical, and 52% of inadequate adjusted therapies). In 26% of patients with inadequate adjusted therapy, antibiotics used were either ineffective against isolated pathogenic bacteria or antibiotic therapy was continued despite negative results of microbiological investigations.

Conclusion

The rate of inadequate antibiotic therapies was similar to the rates reported from other institutions despite the absence of a restrictive antibiotic policy. Surprisingly, adjusted antibiotic therapies were more frequently inappropriate than empirical therapies. Interventions aiming at improving antibiotic prescribing should focus on both initial empirical therapy and streamlining and adjustment of therapy once microbiological results become available.