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Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April–30 June) from 2014–2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014–2016 and 2017–2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p < 0.001) and healthcare-associated infections (HAIs) acquired in PICUs (p < 0.001). Antibiotics were empirical in 7720 infections (85.6%), with an increase in appropriate antibiotic indications during the second period (p < 0.001). The main indication for antibiotic adjustment was de-escalation, increasing in the second period (p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs.

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Esta es la versión de autor del artículo publicado en: This is an author produced version of a paper published in: Copyright: © 2018 ElsevierEl acceso a la versión del editor puede requerir la suscripción del recurso Access to the published version may require subscription 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 1 GUIAS DE INGRESO, ALTA Y TRIAGE PARA LAS UNIDADES DE CUIDADOS INTENSIVOS PEDIÁTRICOS EN ESPAÑA GUIDELINES OF ADMISSION, DISCHARGE AND TRIAGE FOR THE PEDIATRIC INTENSIVE CARE UNITS IN SPAIN GUIAS DE INGRESO, ALTA Y TRIAGE PARA LAS UNIDADES DE CUIDADOS INTENSIVOS PEDIÁTRICOS EN ESPAÑA ResumenLa Unidad de Cuidados Intensivos Pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica.La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España.Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica. GUIDELINES OF ADMISSION, DISCHARGE AND TRIAGE FOR THE PEDIATRIC INTENSIVE CARE UNITS IN SPAIN AbstractA Pediatric Intensive Care Unit (PICU) is a separate physical facility or unit specifically designed for the treatment of pediatric patients who, because of the severity of illness or other lifethreatening conditions, require intensive, comprehensive observations and care by staff physicians who have obtained special competence in pediatric intensive care medicine.Timely and personal intervention by an intensivist reduces mortality, reduces length of stay, and decreases cost of care. With the aim of honoring the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health and guaranteeing quality of care and the safety of critically ill pediatric patients, the Spanish Association of Pediatrics (AEP), Spanish Society of Pediatric...

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