Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription

Goycochea-Valdivia, Walter Alfredo; Moreno-Ramos, Francisco; Paño‐Pardo, José Ramón; Santos, Francisco Javier Aracil; Baquero-Artigao, Fernando; Rabes, T. del Rosal; Peña, M.J. Mellado; Escosa-García, Luis

doi:10.1016/j.eimc.2017.01.011

Cited by 17 publications

(13 citation statements)

References 26 publications

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“…9,10,[27][28][29][30] However, positive results of CMV-PCR in CSF (CSF-CMV-PCR) in infants with symptomatic cCMV have not been frequently reported. 18,31 The role of abnormal findings in CSF as markers of brain damage and predictors of neurologic sequelae is still controversial. The aim of our study was to evaluate a diagnostic value of the positive results of CSF-CMV-PCR in newborns with cCMV.…”

mentioning

confidence: 99%

The Limitations of Cytomegalovirus DNA Detection in Cerebrospinal Fluid of Newborn Infants With Congenital CMV Infection: A Tertiary Care Neonatal Center Experience

Czech‐Kowalska¹,

Jedlińska-Pijanowska²,

Kasztelewicz³

et al. 2021

Pediatric Infectious Disease Journal

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Background: Congenital cytomegalovirus (cCMV) infection of the central nervous system (CNS) can cause ventriculomegaly, gliosis, calcifications and cortical defects. Detection of CMV DNA in cerebrospinal fluid by PCR (CSF-CMV-PCR) is a marker of CNS involvement. Objective: To evaluate a diagnostic value of the positive CSF-CMV-PCR in cCMV. Methods: Analysis of clinical, laboratory, neuroimaging and single-nucleotide polymorphisms (SNPs) data according to the results of CSF-CMV-PCR were performed in infants with cCMV. Results: A total of 168 infants were included; 145 (86.3%) had negative and 23 (13.7%) had positive CSF-CMV-PCR results. Associations between the positive CSF-CMV-PCR results and prematurity (odds ratio [OR] = 3.24; 95% confidence interval [CI]: 1.30–8.07), microcephaly (OR = 5.67; 95% CI: 2.08–15.41), seizures (OR = 4.15; 95% CI: 1.10–15.67), sensorineural hearing loss (OR = 6.6; 95% CI: 2.49–17.46), splenomegaly (OR = 8.13; 95% CI: 3.12–21.16), hepatitis (OR = 10.51; 95% CI: 3.31–33.35), petechiae (OR = 10.21; 95% CI: 3.78–27.57) and heterozygous T/C genotype at TLR4rs4986791 (OR = 7.88; 95% CI: 1.55–40.12) were observed. When using a multivariate logistic regression analysis, only the presence of severe sensorineural hearing loss (OR = 7.18; 95% CI: 1.75–29.34, P = 0.006), cystic lesions on MRI (OR 5.29; 95% CI: 1.31–21.36, P = 0.02), and calcifications on MRI (OR = 7.19; 95% CI: 1.67–30.97, P = 0.008) remained as the significant independent predictors of the positive CSF-CMV-PCR results. Conclusions: The detection of CMV DNA in CSF is associated with a higher rate of CNS damage including abnormal MRI neuroimaging and severe hearing loss. Therefore, detection of CMV DNA in CSF may be considered as a marker of severe CNS injury in cCMV infection. However, the very low prevalence of the positive CSF-CMV-PCR results, even in infants with proven CNS involvement, may imply its limited role in clinical practice.

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confidence: 99%

The Limitations of Cytomegalovirus DNA Detection in Cerebrospinal Fluid of Newborn Infants With Congenital CMV Infection: A Tertiary Care Neonatal Center Experience

Czech‐Kowalska¹,

Jedlińska-Pijanowska²,

Kasztelewicz³

et al. 2021

Pediatric Infectious Disease Journal

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“…Our ASP was able to evaluate over 50% of all prescriptions within the recommended timeframe of 48-72 h after the initial prescription [3,37]. As previously described [38,39], the most frequent reason for a prescription being considered nonoptimal was excessive duration of treatment. In our case, this was especially striking in phlegmonous appendicitis.…”

Section: Discussionmentioning

confidence: 91%

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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“…Several reports around the world identified a high rate of inappropriate antimicrobial prescription (15,16). The main problems identified are an unnecessary indication, wrong antibiotics chosen, wrong directions, incorrect posology, prolonged prescrip- tions, and the use of agents with an excessively broad coverage spectrum (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Quality Analysis of Antimicrobial Restriction Policy in Pediatrics

Silva

Dias

2021

Arch Pediatr Infect Dis

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Background: Antimicrobial stewardship programs (ASPs) are coordinated programs developed in recent years to promote the appropriate use of antimicrobials and reduce microbial resistance. One important action for a successful ASP is the implementation of an antimicrobial policy restriction. Objective: The study analyzed the quality of target-antimicrobial requisitions after the introduction of an antimicrobial policy restriction for children. Methods: We conducted a retrospective study in a neonatal intensive care unit (NICU) and three pediatric intensive care units (PICUs). An ASP was implemented in October 2016, and 14 target antimicrobials were selected to be prescribed after pre-approval by a pediatric infectious disease specialist. All requisitions were analyzed according to indication, antimicrobial type, dose, duration, and collection of cultures before administration. There were no exclusion criteria for requisition analysis. Results: Between October 2016 and December 2017, 1,173 patients were admitted to the units with 120 requisitions of target antimicrobials. Sepsis (43/120; 35.8%) was the most common indication, followed by respiratory infections (23/120; 19.2%) and infections in two or more sites (11/120; 9.2%). The most common target antimicrobials requested were meropenem (68/120; 56.7%), amphotericin B lipid formulations (12/120; 10%), teicoplanin (11/120; 9.2%), and linezolid (11/120; 9.2%). In 98 (81.7%) cases, previous cultures before antimicrobial administration were collected. An infectious agent was detected in 52 of the 98 cultures (53.1%), and Gram-negative and Gram-positive bacteria represented 50% and 26.9% of all positive samples, respectively. Besides, 111 (92.5%) requisitions were approved. In five refused requisitions, a narrow-spectrum antimicrobial was prescribed after further discussion; four were refused due to lack of information, and in one case, the de-escalation of the antimicrobial was possible. No mistake regarding dosage and duration was detected. Conclusions: We found a high-quality rate of target antimicrobial requisition. Antimicrobial policy restriction could contribute to improving the quality of antimicrobial prescription, even in NICUs and PICUs.

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Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription

Cited by 17 publications

References 26 publications

The Limitations of Cytomegalovirus DNA Detection in Cerebrospinal Fluid of Newborn Infants With Congenital CMV Infection: A Tertiary Care Neonatal Center Experience

The Limitations of Cytomegalovirus DNA Detection in Cerebrospinal Fluid of Newborn Infants With Congenital CMV Infection: A Tertiary Care Neonatal Center Experience

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

Quality Analysis of Antimicrobial Restriction Policy in Pediatrics

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