A survey aimed to describe the prevalence of antibiotic use in hospitalised children was conducted in June 2007, in Bambino Gesù Children's Hospital in Rome which has the highest annual number of inpatients among paediatric hospitals in Italy. Data were collected by reviewing medical charts of all patients hospitalised for >48 hours. A total of 412 hospitalised children were evaluated; their median age was 42.3 months, and 55.6% were males. Antibiotics were prescribed to 181 of the 412 patients (43.9%). The prevalence was lowest (37.7%) in medical wards, higher (51.1%) in intensive care units and highest (52.2%) in surgical wards. Of the patients treated with antibiotics in surgical wards, 71% received the treatment as prophylaxis. The most frequently prescribed antibiotics were ceftazidime and the combination of amoxicillin and clavulanic acid. The observed prevalence of antibiotic use was within the range recently reported from other paediatric hospitals in Europe; however, it is advisable to collect data from all over the country in order to identify priority areas and design interventions. These results also highlight the need to implement guidelines for surgical prophylaxis in children, and to further investigate reasons for prescription of parenteral antibiotic therapy in paediatric hospitals.
Implementation of antimicrobial stewardship program is a pivotal practice element for healthcare institution. We developed a remote infectious disease consultancy program via telemedicine in a high-specialized pediatric cardiac hospital. A consultation for antibiotic strategy for each patient was available via telemedicine in addition to biweekly discussion of all clinical cases. Aim of this study was to evaluate the impact of the remote stewardship program in terms of a) appropriateness of antibiotic prescription; b) incidence of multi-resistant infection; and c) cost. A ‘before - after’ study was performed comparing the period immediately before starting the program and one year after. There was a trend in the reduction of nosocomial infectious disease rate (9.5 vs 6.5 per 1000 person days), with a reduction in the overall antibiotic cost (25,000 vs 15,000 EUR) and in the average antibiotics packages used per admission (9 vs 6.7 packages). A significant reduction in the multi-drug resistant isolation rate was observed (104 vs 79 per 1000 person days, p = 0.01). In conclusion, the infectious disease meeting via telemedicine has been an effective tool for economic and professional development and multidisciplinary management of complex patients. The appropriate use of antibiotics reduced the multi-drug resistant bacteria selection, thus improving patient safety.
Background Few data are available about temporal trends of antibiotic use in hospitalized children. The aim of the current study was to investigate the pattern and trends of antibiotic use over the years 2008–2016 in the largest children’s hospital in Italy. Methods Annual point prevalence surveys of antibiotic use were conducted by reviewing medical charts of 0–17 year-old children hospitalized for ≥48 h. Prevalence of antibiotic use was computed by year, type of ward and indication. Trends in prevalence over time were evaluated using the Cochrane-Armitage test. Possibile determinants of antibiotic use were assessed at univariate analysis and through a logistic regression model. Results Out of 3015 children, 1516 (50.3%) received antibiotics, 58.1% of which for medical/surgical prophylaxis. Prevalence of antibiotic use increased from 42.0% in 2008 to 56.2% in 2016 ( p = 0.001). The prevalence of patients receiving antibiotics for medical prophylaxis increased from 6.1% in 2008 to 24.2% in 2016 ( p < 0.001), whereas the prevalence of patients receiving antibiotics for surgical prophylaxis significantly decreased (from 13.7 to 11.8%; p = 0.04); no significant temporal trends were found in antibiotic use for treating infections. The administration of third-generation cephalosporins for surgical and medical prophylaxis significantly decreased over time, while the proportion of antibiotics prescribed to treat infections after microbiological investigations significantly increased. Year (ORadj: 1.8 in 2016 compared to 2008, p < 0.001), age (ORadj ≥1.5 in children ≥1 year, compared to infants ≤2 months, p < 0.001), length of stay (LOS) (OR adj : 1.4 in case of LOS between 8 and 30 days compared to LOS ≤ 7 days, p < 0.001), and type of ward (ORadj: ≥1.3 in intensive-care, surgical and medical-subspecialty units compared to medical units, p < 0.001) were significantly and independently associated with antibiotic use. Conclusions Comparing prevalence rates of antibiotic use among hospitals and over time should consider differences in patient characteristics, such as age, ward of hospitalization and length of stay. Over the years, we documented an improvement in the choice of antibiotics prescribed for medical and surgical prophylaxis. However, further efforts are needed to avoid antibiotic misuse for medical prophylaxis, and to reduce the empirical use of broad spectrum antibiotics. Electronic supplementary material The online version of this article (10.1186/s13052-019-0645-7) contains supplementary material, which is available to authorized users.
Background Children’s hospitals deal with young patients, who have greater variability than adults, therefore size of the medical devices ranges from the newborn to the adult-like patient. This complexity is associated with higher costs to ensure safety and logistics. In June 2014 Bambino Gesù Children’s Hospital (OPBG) adopted an outsourced service for medical device acquisition and stock records for the execution of cath-lab and heart surgery interventions. Goal To evaluate the services effectiveness multi-dimensionally in terms of cost saving, safety, outcomes and operator satisfaction. We measured costs and indicators in pre and post intervention. Materials and methods. We compared the years from 2013 to 2017 in terms of cost-related device and prosthesis consumption, including mean costs per intervention using ANOVA with Tukey’s Post-hoc test. To evaluate the clinical proxy outcome we calculated the pediatric index of mortality for each year. Results In 2013-2017 we performed a mean of 1985 (ds 140) procedures per year with devices, the sample is homogeneous in size and clinical complexity. The trend shows a solid decrease of expenses after the service introduction: we observed a reduction of 20% of the mean consumption per intervention between year 2013 and year 2017 (1707€ vs 1391€) P < 0.001. For what concerns outcomes we noticed a reduction of Standardized Mortality Ratio index from 0.51 to 0.27 (CI 0.18-0.42) in 2014-2017. Discussion Outcome indicators excludes any increase of risk following the adoption of the service. The hospital pharmacy did not receive any reports regarding incidents attributable to the service. The nurses evaluated the service positively regarding the availability, traceability of the devices and decrease of the warehouse work. Conclusions Outsourced service has been cost saving, safe and well accepted by operators and in our opinion is replicable also in other highly complex pediatric hospital settings. Key messages Children hospitals are associated with higher costs to ensure safety and logistics in surgery and cath-lab with medical devices. Outsourced management service can promote cost saving and safety.
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