Assesing Appropriateness of Antimicrobial Treatment in Hospitalized Patients; A Point Prevalence Study

BACKGROUND: Between 20 and 50% of antibiotic therapy in hospitalized patients is considered inappropriate. Inappropriate antibiotic therapy is associated with increased morbidity and mortality. The aim of our study was to evaluate the ratio of appropriate antibiotic therapy among adult patients admitted to a secondary hospital and treated with at least one systemic antibiotic therapy, and to compare different methods for evaluation of appropriateness. METHODS: This was a point-prevalence study, in which all adult patients admitted to a secondary hospital and treated with systemic antibiotic therapy (orally or intravenous) were included. Appropriateness was evaluated by experts (infectious diseases specialist and a clinical pharmacist specializing in antibiotic therapy), and by ranking 11 quality indicators based on literature recommendations. Agreement between all methods was analyzed. RESULTS: 106 patients were included in the study; most of them were treated empirically (78%). Almost half of the patients were treated for urogenital and abdominal infections (44%). Appropriateness ranged from 20-75%, depending on method of evaluation. We found a very low agreement between the more strict definition and experts’ opinion (kappa=0.068), and a medium agreement between the less strict definition and experts’ opinion (kappa=0.45). Respiratory tract infections were treated inappropriately most of the time, according to all evaluation methods. Appropriate blood cultures were taken before starting antibiotic therapy only in 22% of the cases. CONCLUSION: We found a high rate of inappropriate antibiotic therapy in different indications for therapy, both by objective definitions, and by experts’ opinions (although to a lesser amount in the latter). We need to use strict and uniform parameters in order to optimize antibiotic therapy in the hospital. Immediate interventions must be made regarding appropriate blood cultures’ collection, and to improve empiric treatment for respiratory tract infections. DISCLOSURES: All authors: No reported disclosures.