Factors associated with adherence to infectious diseases advice in two intensive care units

• Published in: Journal of antimicrobial chemotherapy Vol. 57; no. 3; pp. 546 - 550
• Main Authors: Pulcini, Céline, Pradier, Christian, Samat-Long, Corinne, Hyvernat, Hervé, Bernardin, Gilles, Ichai, Carole, Dellamonica, Pierre, Roger, Pierre-Marie
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2006; Oxford Publishing Limited (England)
• Subjects: Aged; Anti-Bacterial Agents - standards; Anti-Bacterial Agents - therapeutic use; antibiotic prescriptions; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial Infections - drug therapy; Biological and medical sciences; Cohort Studies; Drug Utilization; Female; Guideline Adherence; Humans; ICUs; ID physicians; Infection Control - standards; Intensive Care Units - standards; Male; Medical sciences; Middle Aged; Multivariate Analysis; Pharmacology. Drug treatments; Practice Guidelines as Topic; Practice Patterns, Physicians; Infection; ID physicians; Health staff; Medical prescription; Risk factor; Physician; antibiotic prescriptions; ICUs; Antibacterial agent; Adhesion; Intensive care unit
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dki483

Objectives: Several studies have reported that infectious diseases (ID) consultations improve the quality of antibiotic prescription, providing adherence is adequate. The aim of this study is to determine the factors associated with adherence to such therapeutic advice. Patients and methods: We conducted a prospective study in two intensive care units (ICUs) over a 6 month period. Systematic bedside diagnostic and therapeutic ID advice was delivered for all patients receiving antibiotic therapy. Results: A total of 381 consultations for 195 patients were recorded, 244 (64%) in ward A and 137 (36%) in ward B. The median SAPS score was 45 and the mortality rate was 23%. Infections accounted for 220 (58%) admissions. A diagnostic discrepancy between ID and intensive care specialists was noted in 125 (33%) cases. The ID specialist advised continuation of the same antibiotic therapy in 138 (36%) cases, a change in 154 (41%) and withdrawal in 89 (23%). Adherence to ID therapeutic advice was recorded for 326 (86%) cases. Multivariate analysis identified two factors independently associated with adherence: ward B [odds ratio (OR), 4.9; 95% confidence interval (CI), 2.0–12.1] and proposition to pursue the same therapy (OR, 4.8; 95% CI, 1.6–14.5). Conclusions: Patients' characteristics and antibiotic therapy modalities do not influence adherence to ID consultation. In contrast, the ward and its characteristics play a major role in adherence to ID advice.