Opportunities to improve antimicrobial use in paediatric intensive care units: a nationwide survey in Spain

Abstract

Improving antimicrobial use is a complex process that requires an accurate assessment of ongoing problems and barriers. Paediatric intensive care units (PICU) have seldom been assessed from this perspective. Two Internet-based, self-administered surveys were conducted nationwide in Spain between January and February 2014. The first survey aimed to assess those characteristics of Spanish PICUs that could influence antimicrobial prescribing or antimicrobial stewardship. The second survey targeted Spanish PICU physicians and pursued to assess their attitudes and perceptions regarding antimicrobial resistance and antimicrobial use. Information about 29/39 contacted PICUs was obtained. A total of 114/206 (55.3%) paediatric intensivists responded. PICUs were heterogeneous regarding years since foundation, number of beds, type of patients admitted and staffing. Only 11 (37.9%) PICUs had available e-prescribing systems. Procalcitonin was available in 24 (89.1%) PICUs, but there were no procalcitonin-based protocols in 14 (60.9%) of them. Half of surveyed PICUs had implemented antimicrobial stewardship activities. Ninety-eight of the 114 PICU physicians (86%) who participated considered that antimicrobial resistance was a significantly relevant problem for their daily and that improving antimicrobial use in their PICU should be a priority (103; 90.4%). The main perceived problems regarding antimicrobial use were the excessive use of antimicrobials in patients with nonconfirmed infections and excessive use of broad-spectrum antimicrobials. The most valued antimicrobial stewardship interventions were the implementation of protocols to guide antimicrobial therapy. Spanish PICU doctors are aware of the relevance of the problem of antimicrobial resistance and the need to improve antimicrobial use. Targeted interventions should take into account their difficulties and preferences when feasible.

European intensive care physicians’ experience of infections due to antibiotic-resistant bacteria

“…A survey with the same target group, but focusing on the concept of “salvage treatment” and indications for and dosing of specific antibiotics has been conducted by the ESCMID study group for critically ill patients [19]. Other surveys have been conducted in different physician populations or countries, including medical residents of two university hospitals in France and Scotland who were not always working in ICUs or in the position to make decisions about antibiotic treatment [20], physicians of 16 ICUs in the United States with a focus on only Gram-negative MDR bacteria [21], and physicians of only one European country, such as Italy (175 Italian ICUs) [22] or Spain (114 paediatric ICU physicians) [23]. One global survey was investigating specifically the use of polymyxins [24].…”

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

“…49 Critical care physicians acknowledge that the problem of antimicrobial resistance is relevant to their daily practice and that optimization of antibiotic prescribing behaviors should be a significant priority. 49,50 Intensivists must concurrently balance these concerns with the recognized need for prompt antibiotic initiation for pediatric sepsis and while bearing in mind that approximately one-half of all ICU patients are diagnosed with bacterial infections. [51][52][53] Major ASP challenges in PICU settings include widespread variability regarding use of available diagnostic testing methods and the relative ambiguity with interpretation of results.…”

“…The study authors concluded that the chronology of empiric antibiotic use guideline development and implementation followed by ongoing ASP PAF was a key factor in their success. 57 Intensivists note that multidisciplinary creation of locally adapted clinical practice guidelines and management protocols are perhaps the most valuable of AS interventions, 50 and intensivists should be empowered to take a leading role in their creation, implementation and maintenance. ASP members contribute valuable expertise to this process, including knowledge of local antimicrobial susceptibility patterns that can influence empiric treatment decisions.…”

The Barriers in the implementation of Antimicrobial Stewardship Programs: A systematic Review

“…Social barriers such as perception of resistance, mistrust in antibiotic guidelines, and the skepticism of antimicrobial stewardship importance also affect the application of ASPs. (6,11,15) Other studies reported that sociocultural beliefs, logistic barriers, and ethical concerns put impact in the implementation of ASPs (8,13).…”