Factors predictive of inappropriateness in requests for parenteral antimicrobials for therapeutic purposes: A study in a small teaching hospital in Brazil

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dc.contributor.authorKawanami, Gustavo Hideki [UNESP]
dc.contributor.authorFortaleza, Carlos Magno Castelo Branco [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2014-05-20T13:34:31Z
dc.date.available2014-05-20T13:34:31Z
dc.date.issued2011-07-01
dc.description.abstractBackground: The identification of patterns of inappropriate antimicrobial prescriptions in hospitals contributes to the improvement of antimicrobial stewardship programs (ASP). Methods: We conducted a cross-sectional study to identify predictors of inappropriateness in requests for parenteral antimicrobials (RPAs) in a teaching hospital with 285 beds. We reviewed 25% of RPAs for therapeutic purposes from y 2005. Appropriateness was evaluated according to current guidelines for antimicrobial therapy. We assessed predictors of inappropriateness through univariate and multivariate models. RPAs classified as 'appropriate' or 'probably appropriate' were selected as controls. Case groups comprised inappropriate RPAs, either in general or for specific errors. Results: Nine hundred and sixty-three RPAs were evaluated, 34.6% of which were considered inappropriate. In the multivariate analysis, general predictors of inappropriateness were: prescription on week-ends/holidays (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.20-2.28, p = 0.002), patient in the intensive care unit (OR 1.57, 95% CI 1.11-2.23, p = 0.01), peritoneal infection (OR 2.15, 95% CI 1.27-3.65, p = 0.004), urinary tract infection (OR 1.89, 95% CI 1.25 -2.87, p = 0.01), combination therapy with 2 or more antimicrobials (OR 1.72, 95% CI 1.15-2.57, p = 0.008) and prescriptions including penicillins (OR 2.12, 95% CI 1.39-3.25, p = 0.001) or 1(st) generation cephalosporins (OR 1.74, 95% CI 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR 0.34, 95% CI 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR 0.04, 95% CI 0.01-0.26, p = 0.001) and requests for agents with an insufficient antimicrobial spectrum (OR 0.14, 95% CI 0.03-0.30, p = 0.01). Conclusions: Our results demonstrate the importance of previous consultation with an ID specialist in assuring the quality of prescriptions. Also, they highlight prescription patterns that should be approached by ASP policies.en
dc.description.affiliationSão Paulo State Univ, UNESP, Botucatu Sch Med, Dept Trop Dis & Imaging Diag, Botucatu, SP, Brazil
dc.description.affiliationSão Paulo State Univ, Botucatu Sch Med, Bauru State Hosp, UNESP, Bauru, SP, Brazil
dc.description.affiliationUnespSão Paulo State Univ, UNESP, Botucatu Sch Med, Dept Trop Dis & Imaging Diag, Botucatu, SP, Brazil
dc.description.affiliationUnespSão Paulo State Univ, Botucatu Sch Med, Bauru State Hosp, UNESP, Bauru, SP, Brazil
dc.format.extent528-535
dc.identifierhttp://dx.doi.org/10.3109/00365548.2011.565795
dc.identifier.citationScandinavian Journal of Infectious Diseases. London: Informa Healthcare, v. 43, n. 6-7, p. 528-535, 2011.
dc.identifier.doi10.3109/00365548.2011.565795
dc.identifier.issn0036-5548
dc.identifier.urihttp://hdl.handle.net/11449/11844
dc.identifier.wosWOS:000291662600016
dc.language.isoeng
dc.publisherInforma Healthcare
dc.relation.ispartofScandinavian Journal of Infectious Diseases
dc.rights.accessRightsAcesso restrito
dc.sourceWeb of Science
dc.subjectAntimicrobialsen
dc.subjectantimicrobial stewardshipen
dc.subjectcross-sectional studyen
dc.titleFactors predictive of inappropriateness in requests for parenteral antimicrobials for therapeutic purposes: A study in a small teaching hospital in Brazilen
dc.typeArtigo
dcterms.licensehttp://informahealthcare.com/page/resources/authors
dcterms.rightsHolderInforma Healthcare
unesp.author.lattes2589937673452910[2]
unesp.author.orcid0000-0003-4120-1258[2]
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt

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