Benefits of a Pediatric Antimicrobial Stewardship Program in Antimicrobial Use and Quality of Prescriptions in a Referral Children's Hospital

Velasco-Arnaiz, Eneritz; Simó-Nebot, Silvia; Ríos-Barnés, María; Ramos, María Goretti López; Monsonís, Manuel; Urrea-Ayala, Mireia; Jordan, Iolanda; Mas-Comas, Anna; Casadevall-Llandrich, Ricard; Ormazábal-Kirchner, Daniel; Cuadras, Daniel; Pérez-Pérez, Cristina; Millet-Elizalde, Marta; Sánchez-Ruiz, Emilia; Fortuny, Clàudia; Noguera-Julián, Antoni

doi:10.1016/j.jpeds.2020.06.008

Cited by 20 publications

(27 citation statements)

References 42 publications

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“…Studies have shown that this approach is effective in controlling irrational antibiotic use in various settings across the world, regardless of their levels of economic development [12][13][14][15][16]. However, we found little evidence about the patterns and appropriateness of antibiotic use in children in PHIs [17,18]. To explore how antibiotics were used for children in PHIs, this study aims to determine the patterns and appropriateness of antibiotic prescriptions among children in PHIs in Beijing between 2017 and 2019.…”

Section: Introductionmentioning

confidence: 99%

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

Wushouer

Chen

et al. 2021

Antibiotics

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(1) Background: Few studies have focused on antibiotic use and appropriateness in children in primary health institutions (PHIs). This study aimed to identify the patterns and appropriateness of antibiotic use for children in PHIs in Beijing, China. (2) Methods: Outpatient prescriptions of 327 PHIs from 2017 to 2019 for patients < 18 years old were collected. Prescriptions were described using quantity indicators. Antibiotics were categorized according to ATC classification J01 and Access, Watch, Reserve grouping. Appropriateness was reviewed by experts using three subtypes of irrational prescriptions (irregular, inappropriate, and abnormal). (3) Results: 20,618 prescriptions were collected in total. The antibiotic prescription rate (APR) was 15.1% (N = 3113). Among antibiotic prescriptions, J01FA Macrolides were the most used (N = 1068, 34.9%). The Watch group constituted 89.0% (N = 2818) of total antibiotic use. Bronchitis (N = 1059, 35.2%) was the most common diagnosis. A total of 292 instances of irrational antibiotic use were identified, with inappropriate prescriptions being the most prevalent subtype (N = 233, 79.8%). (4) Conclusion: Although APR for children in PHIs in Beijing was relatively low, the pattern of antibiotic use differed from other countries. Further studies are needed to optimize antibiotic use for children in PHIs under different levels of economic development.

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Section: Introductionmentioning

confidence: 99%

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

Wushouer

Chen

et al. 2021

Antibiotics

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“…From March 16 to April 30 2020, 210 randomly selected prescriptions were assessed for quality. 3 Because SARS-CoV-2 is a viral infection, it is not expected to directly influence antibiotic or antifungal use beyond the use of antibiotics with possible antiviral effect (ie, azithromycin) 4 and the use of broad-spectrum antibiotics for superinfection in severe COVID-19 patients. 5 However, we also observed antimicrobial use changes indirectly related to the outbreak.…”

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confidence: 99%

Pediatric antimicrobial stewardship in the COVID-19 outbreak

Velasco-Arnaiz

Simó-Nebot

Jordán

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Our ASP (Programa de Optimización del uso de Antimicrobianos Sant Joan de Déu, PROA-SJD) was implemented in January 2017 [7]. The ASP core team was composed of a full-time paediatric infectious diseases specialist, and part-time physicians including a paediatric intensive care specialist, a clinical pharmacist, a microbiologist and an infection control and hospital epidemiology physician.…”

Section: Intervention: Proa-sjdmentioning

confidence: 99%

“…Based on evaluation of the main aspects of diagnosis and treatment, antimicrobial prescriptions were considered "optimal" or "nonoptimal" [7,[44][45][46]. For a prescription to be considered "optimal", all the following criteria had to be met: (1) the administration of the antimicrobial was appropriate considering the diagnosis, antimicrobial spectrum, and our own protocols (Table 2), was adapted to local epidemiology, and also accounted for patient allergies and comorbidities; (2) the drug was given via the right route, and at the right dose and with the right schedule; and (3) the expected and/or actual duration of the antimicrobial treatment was appropriate [7]. For "nonoptimal" prescriptions, feedback with recommendation to discontinue or to modify therapy was provided daily in the patient's electronic clinical chart and also face-to-face or by phone during morning rounds with the surgical team.…”

Section: Intervention: Proa-sjdmentioning

confidence: 99%

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Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

et al. 2020

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The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

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Benefits of a Pediatric Antimicrobial Stewardship Program in Antimicrobial Use and Quality of Prescriptions in a Referral Children's Hospital

Cited by 20 publications

References 42 publications

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

Pediatric antimicrobial stewardship in the COVID-19 outbreak

Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

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