Distribution of antimicrobial guidelines: Useful but not enough for an antibiotic stewardship

Purpose > Evaluate the impact of distribution of antimicrobial guidelines (AG) on anti-infectious prescriptions (AIP) in patients presenting a bacteraemia. Cost evaluation of AIP with and without intervention of an infectious disease specialist. Methods > The first evaluation of AIP was performed from January to May 2008 in Douai hospital, France, at day 4 after the initial blood sample using French guidelines (FG). An AG based on FG was distributed in June 2008 to all Medical Doctors. A second evaluation of AIP was performed from July 2009 to October 2010 after AG distribution. In May 2009, an infectious disease specialist arrived. He re-evaluated at day 4 the initial AIP and modified it if necessary based on the bacteriologic results and the AG. In the second period of the study, we evaluated the cost of the AIP after day 4. Results > Anti-infectious at day 1 was suitable in 37/50 (74%) cases before vs. 148/206 (72%) cases after distribution of the AG (P = 0.76). At day 4, anti-infectious was suitable in 26/50 (52%) before vs. 103/206 (50%) cases after distribution of the AG (P = 0.80). In the second period, the overall cost of AIP was estimated at 44,000 Euros with the infectious disease specialist intervention and at 51,000 Euros without. Conclusion > Distribution of AG did not significantly improve AIP in patients with bacteraemia. Re-evaluation by an infectious disease specialist could lead to a better anti-infectious usage and potential reduction in costs.