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.

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