Australia‐wide point prevalence survey of the use and appropriateness of antimicrobial prescribing for children in hospital

Osowicki, Joshua; Gwee, Amanda; Noronha, Jesuina; Palasanthiran, Pamela; McMullan, Brendan; Britton, Philip N; Isaacs, David; Lai, Tony; Nourse, Clare; Avent, Minyon; Moriarty, Paul; Clark, Julia; Francis, Joshua; Blyth, Christopher C; Cooper, C; Bryant, Penelope A

doi:10.5694/mja13.00154

Cited by 36 publications

(44 citation statements)

References 22 publications

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“…In this investigation, around 63% of the subjects were male. These statistic figures are extensively like reports from open public hospitals in other developing countries, for example, Ethiopia [15][16][17] and Nepal [18]. The most widely indication for antibiotic use in our series was pneumonia (10.2%), trailed by other lower respiratory tract diseases (9.4%).…”

Section: Discussionsupporting

confidence: 77%

Antibiotic Use in Pediatric Infections; A Study in Tertiary Care Hospital

Gungam¹,

Yadav²,

Junapudi³

2018

IJCBR

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Objectives: Antibiotics are frequently used in tertiary care hospitals. We conducted an observational study on children admitted to a teaching hospital in south India, to make a profile of antibiotics use and suspected adverse drug reactions (ADRs) owing to them. Methods: Hospitalized children of either sex, aged between 1 month and 12 years, were inspected. Baseline demographic and clinical features, duration of hospital stay, antibiotics received in hospital along with dosing and indications and interest of suspected ADRs attributable to their use were recorded. Every patient was followed up till discharge, admission to the Pediatric Intensive Care Unit, or passing. Results: Over the year and a half report period 364 confirmations were screened. The prevalence of Antibiotics use was 80.22%. The majority of the 292 children who received Antibiotics were males (63.35%). Median age was 35 months, five children died. In most instances, either two (41%) or a single antibiotic (37.32%) was used. Ceftriaxone, co-amoxiclav, amikacin, vancomycin, and ampicillin were predominantly used. Antimalarials, antivirals and antiprotozoals were used occasionally. Average number of Antibiotics per patient was 2.2± 1.1 the majority (81.15%) were by parenteral route and initial choice was usually empirical. Prescriptions were usually in generic name. The antibiotic treatment went somewhere in the range of 1 and 32days, with a middle of 8 days. Five ADRs were noted of which half were skin rash and the rest loose stools. Conclusions: The profile of Antibiotic utilize is comprehensively like prior Indian investigations. Apparent overuse of multiple Antibiotics per prescription and the parenteral route requires exploration. Antibiotics are being used empirically in the absence of policy. ADRs to Antibiotics are occasional and usually mild. The benchmark information can serve in situation analysis for antibiotic prescribing guidelines.Keywords: Antibiotic; Pediatric infections; Adverse drug reactions; Tertiary care hospital.

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Section: Discussionsupporting

confidence: 77%

Antibiotic Use in Pediatric Infections; A Study in Tertiary Care Hospital

Gungam¹,

Yadav²,

Junapudi³

2018

IJCBR

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“…This was primarily due to the misuse of broad-spectrum antibiotics [10]. Similar rates of inappropriate prescribing (28%) occur with children [11]. Although the findings of this pilot study echo the broader nation-wide results, drawing definitive conclusions is not possible due to the small sample size.…”

Section: Antibiotic Usesupporting

confidence: 52%

Multidrug resistant gram-negative bacteria in Tasmania: An audit based pilot study

Heazlewood

Ogden

McCann

2016

Infection, Disease & Health

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Objectives: Multidrug resistant gram-negative (MRGN) bacteria are increasing in prevalence globally. Accurate prevalence data contributes to limiting the proliferation of these organisms. The aim of this research was to identify the prevalence of MRGN bacteria within an Australian health district and to establish the risk factors associated with their acquisition through the development and piloting of a novel audit tool. Methods: An audit based pilot study was conducted using a specifically developed tool that collected pathology and patient data on all patients with new MRGN bacteria notifications during 2013 in one Australian health district. Results: There were 68 new MRGN bacteria notifications in the health district in 2013; 42 of these had sufficient data for auditing. The majority of bacteria identified were Escherichia coli (n Z 43, 63.2%) and the majority of specimens were urine (n Z 47, 69.1%). Urine specimens were more prevalent in females compared to males (72% vs 28%, c2 13.98, p < 0.001). Sixty-five percent of patients were aged 65 and over (n Z 44), and 25% were aged 85 and over (n Z 17). More than half of the patients with full data available (n Z 22) were administered antibiotics during admission, predominantly broad-spectrum varieties. Conclusions: This pilot study identified several areas of concern, including poor documentation practices, and management of patients with dementia, particularly those with urinary catheters. Discrepancies between antibiotic prescribing practices and Therapeutic Guidelines were identified and an audit of antibiotic prescribing and reasons for deviation could improve practice and reduce the burden of multidrug resistance. Enhanced screening of MRGN bacteria should be considered to provide data for management and tracking of resistance, and could be enhanced through use of the audit tool. ª

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“…Although there have been several large PPS of hospital AMU in the United States [11, 12], Europe [13], Australia [14, 15], and elsewhere [16, 17], PPS of Canadian hospitals are more limited, and are particularly lacking for nonacademic centers [18–20]. To our knowledge, there is also only 1 example of a provincial PPS, conducted in New Brunswick in 2012 [21, 22].…”

mentioning

confidence: 99%

Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Leung

Langford

et al. 2018

Open Forum Infectious Diseases

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BackgroundAntimicrobial stewardship, a key component of an overall strategy to address antimicrobial resistance, has been recognized as a global priority. The ability to track and benchmark antimicrobial use (AMU) is critical to advancing stewardship from an organizational and provincial perspective. As there are few comprehensive systems in Canada that allow for benchmarking, Public Health Ontario conducted a pilot in 2016/2017 to assess the feasibility of using a point prevalence methodology as the basis of a province-wide AMU surveillance program.MethodsThree acute care hospitals of differing sizes in Ontario, Canada, participated. Adults admitted to inpatient acute care beds on the survey date were eligible for inclusion; a sample size of 170 per hospital was targeted, and data were collected for the 24-hour period before and including the survey date. Debrief sessions at each site were used to gather feedback about the process. Prevalence of AMU and the Antimicrobial Spectrum Index (ASI) was reported for each hospital and by indication per patient case.ResultsParticipants identified required improvements for scalability including streamlining ethics, data sharing processes, and enhancing the ability to compare with peer organizations at a provincial level. Of 457 patients, 172 (38%) were receiving at least 1 antimicrobial agent. Beta-lactam/beta-lactamase inhibitors were the most common (18%). The overall mean ASI per patient was 6.59; most cases were for treatment of infection (84%).ConclusionsThis pilot identified factors and features required for a scalable provincial AMU surveillance program; future efforts should harmonize administrative processes and enable interfacility benchmarking.

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Australia‐wide point prevalence survey of the use and appropriateness of antimicrobial prescribing for children in hospital

Abstract: A point prevalence survey is a useful cross-sectional method for quantifying antimicrobial use in paediatric populations. The value is significantly augmented by adding assessment of prescribing quality.

Cited by 36 publications

References 22 publications

Antibiotic Use in Pediatric Infections; A Study in Tertiary Care Hospital

Antibiotic Use in Pediatric Infections; A Study in Tertiary Care Hospital

Multidrug resistant gram-negative bacteria in Tasmania: An audit based pilot study

Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

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