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Master thesis

Evaluation de la qualité des prescriptions antibiotiques dans le service d’accueil des urgences du centre hospitalier général de Sarreguemines

Abstract : Objectives. - To audit antibiotic (ATB) prescribing relevance within the Emergency and Accident Unit in Robert Pax Hospital, in Sarreguemines, Moselle, France, before and after information regarding appropriate prescribing was given to prescribers.Method. - First part of this audit consisted in a retrospective study between april and may 2014. The second part was done between april and may 2014. During these time intervals, all patients treated with ATB in A&E were included in the study. Between the two parts of the audit, protocols reminding local guidelines for ATB prescribing were put in place. Each prescription was then reviewed by 2 A&E doctors and checked against the local guidelines in place in Lorraine. The prescription (PX) was deemed relevant if it the choice of ATB as well as its dispensation were following the guidelines. It was deemed non relevant if the choice of ATB was inappropriate, or if there was no need for ATB in the first place.Results. - 150 patients were included in the study in 2013 and 148 in 2014. Most of them were treated for a urinary, respiratory or cutaneous infection (75% of PX 2013, 80% of PX in 2014). Penicillins were prescribed most, followed for the first part of the audit by quinolones and cephalosporins. For the re-audit, quinolones were less prescribed then cephalosporins. In 2013, 46% of PX were relevant, against 54% in 2014. 25% were inappropriate in 2013 against 20% in 2014. And 29% were not justified in 2013, against 26% in 2014. Conclusion. - Despite issuing all prescribers within A&E with up to date local guidelines, and even if there was an improvement in the re-audit, ATB are still over or inappropriately used. This would have an impact on sensitivities and induce potential resistance. Written and repeated verbal information for prescribers was not enough to improve the outcome. We are now exploring different measures to improve ATB prescribing through protocols, CPD, audits or clinical ATB lead within A&E
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Master thesis
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https://hal.univ-lorraine.fr/hal-01732218
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Suzanne Ley. Evaluation de la qualité des prescriptions antibiotiques dans le service d’accueil des urgences du centre hospitalier général de Sarreguemines. Sciences du Vivant [q-bio]. 2015. ⟨hal-01732218⟩

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