Antibiotic stewardship in the PICU: Impact of ward rounds led by paediatric infectious diseases specialists on antibiotic consumption

Renk, Hanna; Sarmisak, Eva; Spott, C; Kumpf, Matthias; Hofbeck, Michael; Hölzl, Florian

doi:10.1038/s41598-020-65671-0

Cited by 16 publications

(21 citation statements)

References 37 publications

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“…While this demonstrated the significant impact these programs can have as regards reducing antimicrobial use, this study did not specify the impact on PICUs. Another study by Renk et al [ 25 ] assessed the effect and safety of a once-weekly ward round carried out by pediatric infectious disease physicians, looking at antibiotic consumption in a 14-bed multidisciplinary PICU in Germany, measuring antimicrobial utilization by days of therapy (DoT) per 1000 patient-days (PDs); it reported an 18% reduction of DoT/1000 PD in the period following the implementation of the AMS program.…”

Section: Discussionmentioning

confidence: 99%

“…García-Rodríguez et al [ 29 ], in a descriptive pre–post interventional study on the use of meropenem, observed that the appropriateness of meropenem prescriptions and the de-escalation from meropenem treatment to narrower-spectrum antibiotics improved progressively over time after an AMS intervention [ 30 , 31 , 32 ], leading to a significant decrease in meropenem consumption. In our experience, the implementation of comprehensive AMS strategies does modify physicians’ behavior and understanding of the importance of early antibiotic de-escalation and withdrawal as one of the tenets of AMS [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain—What Have We Learned?

et al. 2022

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain—What Have We Learned?

et al. 2022

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Section: Introductionmentioning

confidence: 99%

“…4 Implementation of ABS at a pediatric intensive care unit (ICU) in a German university hospital led to a reduction in antibiotic usage, LoT, and an approximately 50% reduction of meropenem and vancomycin. 5 An ABS intervention at a German non-university tertiary care hospital was implemented and assessed, and antibiotic usage was compared with a German university tertiary care pediatric hospital.…”

Section: Introductionmentioning

confidence: 99%

Opportunities for Antibiotic Stewardship Interventions in a Pediatric Hospital

Grewer-Katona

Hüebner

Pecar

et al. 2022

J Pediatr Infect Dis

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Objective This study's objective was to assess an antibiotic stewardship intervention, compare pediatric antibiotic usage in a non-university hospital (Children's Hospital Traunstein [TS]) with a university hospital (Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich [MUC]), and assess adherence to national guidelines. Methods Antibiotic usage pre- and post-antibiotic stewardship (ABS) intervention was compared, and antibiotic prescriptions over 4 months were prospectively recorded. ABS intervention consisted of weekly teaching sessions, antibiotic pocket cards, and rounds with pediatric infectious disease staff. Medical records were reviewed to describe antibiotic consumption, antibiotic dosages and length of use, and adherence to national guidelines. Pediatric antibiotic usage was compared between hospitals and patient groups. Results After the ABS intervention, the use of second-generation cephalosporins decreased, while penicillin with β-lactamase inhibitors (BLI) increased. Survey of antibiotic prescriptions over the 4 months study period in the non-university hospital showed a high administration rate of second-generation cephalosporins and extended-spectrum penicillins in the non-intensive care units (ICU) wards (48.53 and 38.93 days of therapy [DoT]/1,000 patient days [PD], respectively) and a high rate of third-generation cephalosporins in the ICU ward (110.33 DoT/1,000PD). A high prescriptions rate was seen in the neonatal intensive care unit (NICU) wards (DoT/ length of therapy [LoT] ratio of 2.185). Reserve group antibiotics were only given in the ICU. Adherence to national guidelines was highest in the NICU and pediatric ICU wards. Striking was the relatively high rate of incorrect usage of second-generation cephalosporins. Comparing the pediatric wards of the non-university hospital (TS) and the university hospital (MUC), the prescription ratio was 11.1% (TS) versus 30.6% (MUC), and DoT/1,000PD 198.9 (TS) versus 483.6 (MUC), p = 0.02. ABS intervention changed the choice of described antibiotics, but not the overall frequency. Conclusion Adherence to national guidelines was highest in fields with standardized therapy recommendations, like in the NICU. In MUC, antibiotics, in particular restricted ones, were prescribed more frequently, probably due to higher severity of illness.These data indicate that the usage of antibiotics and adherence to national guidelines show a wide variety, but ABS interventions were effective in changing prescription behavior.

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“…Another recent study described a weekly pediatric infectious disease ward round with the PICU team, in which feedback and recommendations were given. Adherence to recommendations was 79%, and the implementation reduced meropenem (49%) and vancomycin use (56%) (12).…”

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confidence: 99%

Risk and Resistance: Examining Our Antibiotic Use*

Madden¹

2022

Pediatric Critical Care Medicine

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T imely administration of antibiotics in the PICU can be life-saving. Recent initiatives, based on data supporting the survival benefit of antibiotic delivery within 1 hour, have addressed delays and minimized barriers (1, 2). Although controversy may remain about the strength of this evidence, I doubt few of us would object to an emphasis on early antibiotics for a patient with suspected septic shock. What to do when the initial "rule-out" is done, especially when bacterial cultures remain negative-that is a common conundrum addressed in this issue of Pediatric Critical Care Medicine, where Fontela et al (3) offer theoretical models describing clinical decision-making about antibiotic use, based on their study of 21 PICU practitioners.Using qualitative methods, the authors sampled physicians from three PICU sites in Canada, ranging in experience, gender and level of training. Using the theory of grounded behavior, they constructed models that describe the process these PICU practitioners used to make decisions about antibiotic initiation, discontinuation, and course duration. The three models they describe contain four common steps. The first step, as one might suspect, was the evaluation of objective evidence (laboratories, vital signs, imaging studies, as well as an individual patient's risk for overwhelming bacterial infection) to determine antibiotic choice and duration. If uncertainty remained after an objective evaluation, practitioners then turned to a patient safety assessment, described as a moral process incorporating the desire to avoid bad patient outcomes, potential medical-legal impacts, and was highly informed by the practitioner's risk tolerance.Step three follows if uncertainty continues-an intuitive approach that is strongly influenced by the practitioner's own experiences with overwhelming infections. The final step is the deference to expert consultants either published guidelines, if applicable, or more commonly our pediatric infectious disease colleagues (3).In addition to the four-step models, the authors found other factors, like their trust in colleagues' prior decision about antibiotics, were also influential (3). This theme echoed findings of another qualitative study of inpatient antibiotic decision-making by Livorsi et al (4), who also reported that antibiotic overuse is recognized but accepted, and that potential for adverse effects of antibiotic use has limited influence on decision-making. The profound influence of supervisors on their trainees regarding antibiotic practices, as well as reluctance to give feedback to colleagues even when they might critique their decisions, were also important themes (3,4).As the authors highlight, there is an opportunity to improve the reliability of objective data through future study, and research there remains active. Until

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Antibiotic stewardship in the PICU: Impact of ward rounds led by paediatric infectious diseases specialists on antibiotic consumption

Cited by 16 publications

References 37 publications

Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain—What Have We Learned?

Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain—What Have We Learned?

Opportunities for Antibiotic Stewardship Interventions in a Pediatric Hospital

Risk and Resistance: Examining Our Antibiotic Use*

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