Apport d'une consultation systématique d'infectiologie à la maîtrise de l'antibiothérapie en réanimation

The nosocomial infections and multiresistant bacteria increase is a tremendous problem, particularly in intensive care units. Lot of procedures are set in hospitals, in order to obtain the best antimicrobial regimens. We report the results of a systematic infectious advisory consultation, in the intensive care unit of our Universitary hospital. The study was prospective, collecting data before and after the intervention of an infectious diseases expert. The expert visited the Intensive Care Unit daily, for discussion and validation of all anti-infections treatments. We compared antimicrobial drugs quantities during two 3 months periods (without and with the expert's visit). 190 patients were analyzed. The expert's visit led to a 15938.30 € (19.56%) saving. It was mainly obtained by reducing antifungal treatments. These results compared to other studies realized in France or anglo-saxon countries. The obtained saving was reported to be between 15 and 30%, whatever the type and duration of the intervention were. Other interventions are possible: setting guidelines and teaching program, antibiotics turn-over, restrictions for prescribing antimicrobials… The ecological effect is slower than the economical one. In order to maintain a bacterial flora as sensitive to antibiotics as possible, it's necessary to set sophisticated antibiotics policies.