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Kenga DB, Sacarlal J, Sidat M, Amorim G, Myers HH, Chicamba V, Kampa KT, Moon TD. Evaluating empiric antibiotic prescribing for hospitalized children in Mozambique through the introduction of a quarterly syndromic antibiogram: An implementation science protocol. PLoS One 2024; 19:e0306511. [PMID: 39121076 PMCID: PMC11315278 DOI: 10.1371/journal.pone.0306511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/19/2024] [Indexed: 08/11/2024] Open
Abstract
Antimicrobials are the most frequently prescribed drug in pediatrics, with an estimated 37% of infants and 61% of hospitalized children having received them. Approximately 20-50% of prescriptions have been shown to be potentially unnecessary or inappropriate. The World Health Organization (WHO) estimates that the continued increase in antimicrobial resistance by the year 2050 will lead to the death of 10 million people per year. This paper describes a protocol to be used in a future study to evaluate the implementation of a quarterly syndromic antibiogram, aimed to improve the use of antibiotics for the treatment of pediatric bacterial infections at the Maputo Central Hospital, Mozambique. This study uses implementation science methods framed by the Dynamic Adaption Process (DAP) and RE-AIM conceptual frameworks to develop a multi-phase, mixed-methods evaluation utilizing qualitative and quantitative approaches. The pediatric inpatient services at HCM consist of approximately 18 physicians and 60 nurses. Additionally, the microbiology laboratory consists of eight laboratory technicians. We anticipate analyzing approximately 9,000 medical records. Qualitative methods include in-depth interviews with clinicians, laboratory technicians, and administrators to explore current knowledge and practices around antibiotic decision making, facilitators and barriers to intervention implementation, as well as acceptability and satisfaction with the intervention roll-out. Qualitative analysis will be performed with NVivo 12 software. Quantitative methods include extracting data from existing records from the pediatric ward of Hospital Central de Maputo (HCM) guided by the RE-AIM framework to explore intervention utilization and other factors influencing its implementation. Quantitative descriptive and inferential statistical analysis will be performed using R Studio statistical software. The findings from this evaluation will be shared with hospital administrators and relevant national policymakers and may be used by the Ministry of Health in deciding to expand this approach to other hospitals. The expected results of this research include the development of standard operating guidelines for the creation, distribution, and use of a quarterly syndromic antibiogram for antibiotic decision making that is informed by local epidemiology. Findings from this study will be used to develop a larger multi-site trial in Mozambique.
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Affiliation(s)
- Darlenne B. Kenga
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Harriett H. Myers
- Department of Tropical Medicine and Infectious Diseases, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Valéria Chicamba
- Pediatric Intensive Care Unit, Hospital Central de Maputo, Maputo, Mozambique
| | - Kathryn T. Kampa
- Department of Tropical Medicine and Infectious Diseases, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Troy D. Moon
- Department of Tropical Medicine and Infectious Diseases, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
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Rudnick W, Conly J, Thirion DJG, Choi K, Pelude L, Cayen J, Bautista J, Beique L, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, Happe J, Katz K, Kibsey P, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, McKenna S, Neville HL, Slayter K, Suh KN, Tse-Chang A, Weiss K, Science M. Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018. Antimicrob Resist Infect Control 2023; 12:35. [PMID: 37072874 PMCID: PMC10111695 DOI: 10.1186/s13756-023-01219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Antimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals. METHODS Acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd). RESULTS Nine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409-554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd). CONCLUSIONS This study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.
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Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Conly
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Foothills Medical Centre, Alberta Health Services, 3330 Hospital Dr. NW, Calgary, AB, T2N 2T9, Canada
| | - Daniel J G Thirion
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Kelly Choi
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Linda Pelude
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Joelle Cayen
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Bautista
- Central Newfoundland Regional Health Centre, 50 Union, Grand Falls-Windsor, NL, A2A 2E1, Canada
| | - Lizanne Beique
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | | | - Bruce Dalton
- Alberta Health Services, 1620 29 St NW, Calgary, AB, T2N 4L7, Canada
| | - Johan Delport
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Rita Dhami
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Joanne Embree
- University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Shared Health Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Children's Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB, R3E 0Z3, Canada
| | - Yannick Émond
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Gerald Evans
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Charles Frenette
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Susan Fryters
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Jennifer Happe
- Infection Prevention and Control Canada, Red Deer, AB, T4N 6R2, Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, North York, ON, M2K 1E1, Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada
| | - Joanne M Langley
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
- Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada
| | - Bonita E Lee
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Marie-Astrid Lefebvre
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jerome A Leis
- Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Allison McGeer
- Sinai Health System, 600 University Ave, Toronto, ON, M5G 1X5, Canada
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Susan McKenna
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Heather L Neville
- Nova Scotia Health, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Kathryn Slayter
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Kathryn N Suh
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Alena Tse-Chang
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Karl Weiss
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
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Vicentini C, Vola L, Previti C, Brescia V, Dal Mas F, Zotti CM, Bert F. Antimicrobial Stewardship Strategies Including Point-of-Care Testing (POCT) for Pediatric Patients with Upper-Respiratory-Tract Infections in Primary Care: A Systematic Review of Economic Evaluations. Antibiotics (Basel) 2022; 11:antibiotics11081139. [PMID: 36010008 PMCID: PMC9404955 DOI: 10.3390/antibiotics11081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Upper-respiratory-tract infections (URTIs) are among the main causes of antibiotic prescriptions in pediatric patients. Over one-third of all antibiotic prescriptions for URTIs in children are estimated to be inappropriate, as the majority of URTIs are caused by viral agents. Several strategies, including clinical scoring algorithms and different point-of-care tests (POCTs) have been developed to help discriminate bacterial from viral URTIs in the outpatient clinical setting. A systematic review of the literature was conducted following PRISMA guidelines with the objective of summarizing evidence from health–economic evaluations on the use of POCT for URTIs in pediatric outpatients. A total of 3375 records identified from four databases and other sources were screened, of which 8 met the inclusion criteria. Four studies were classified as being of high reporting quality, and three were of medium quality. Five out of eight studies concluded in favor of strategies that included POCTs, with an additional study finding several POCTs to be cost-effective compared to usual care but over an acceptable WTP threshold. This review found POCT could be a valuable tool for antimicrobial stewardship strategies targeted towards childhood URTIs in primary care.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Lorenzo Vola
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Christian Previti
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-011-670-5830; Fax: +39-011-670-5889
| | - Valerio Brescia
- Department of Management, University of Turin, 10126 Turin, Italy
| | - Francesca Dal Mas
- Department of Management, Ca’ Foscari University of Venice, Cannaregio, 873, 30100 Venice, Italy
| | - Carla Maria Zotti
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Fabrizio Bert
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy
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Minotti C, Barbieri E, Doni D, Impieri C, Giaquinto C, Donà D. Anti-infective Medicines Use in Children and Neonates With Pre-existing Kidney Dysfunction: A Systematic Review. Front Pediatr 2022; 10:868513. [PMID: 35558367 PMCID: PMC9087830 DOI: 10.3389/fped.2022.868513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Dosing recommendations for anti-infective medicines in children with pre-existing kidney dysfunction are derived from adult pharmacokinetics studies and adjusted to kidney function. Due to neonatal/pediatric age and kidney impairment, modifications in renal clearance and drug metabolism make standard anti-infective dosing for children and neonates inappropriate, with a risk of drug toxicity or significant underdosing. The aim of this study was the systematic description of the use of anti-infective medicines in pediatric patients with pre-existing kidney impairment. Methods A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The EMBASE, Medline and Cochrane databases were searched on September 21st, 2021. Studies in all languages reporting data on pre-defined outcomes (pharmacokinetics-PK, kidney function, safety and efficacy) regarding the administration of anti-infective drugs in children up to 18 years with pre-existing kidney dysfunction were included. Results 29 of 1,792 articles were eligible for inclusion. There were 13 case reports, six retrospective studies, nine prospective studies and one randomized controlled trial (RCT), reporting data on 2,168 pediatric patients. The most represented anti-infective class was glycopeptides, with seven studies on vancomycin, followed by carbapenems, with five studies, mostly on meropenem. Antivirals, aminoglycosides and antifungals counted three articles, followed by combined antibiotic therapy, cephalosporins, lipopeptides with two studies, respectively. Penicillins and polymixins counted one study each. Nine studies reported data on patients with a decreased kidney function, while 20 studies included data on kidney replacement therapy (KRT). Twenty-one studies reported data on PK. In 23 studies, clinical outcomes were reported. Clinical cure was achieved in 229/242 patients. There were four cases of underdosing, one case of overdosing and 13 reported deaths. Conclusion This is the first systematic review providing evidence of the use of anti-infective medicines in pediatric patients with impaired kidney function or requiring KRT. Dosing size or interval adjustments in pediatric patients with kidney impairment vary according to age, critical illness status, decreased kidney function and dialysis type. Our findings underline the relevance of population PK in clinical practice and the need of developing predictive specific models for critical pediatric patients.
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Affiliation(s)
- Chiara Minotti
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Denis Doni
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Cristina Impieri
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy
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5
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:3. [PMID: 31911831 PMCID: PMC6942341 DOI: 10.1186/s13756-019-0659-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
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Affiliation(s)
- D. Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| | - E. Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
| | - M. Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R. Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C. Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Fondazione Penta ONLUS, Padua, Italy
| | - T. Zaoutis
- Fondazione Penta ONLUS, Padua, Italy
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - M. Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
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Barbieri E, Donà D, Cantarutti A, Lundin R, Scamarcia A, Corrao G, Cantarutti L, Giaquinto C. Antibiotic prescriptions in acute otitis media and pharyngitis in Italian pediatric outpatients. Ital J Pediatr 2019; 45:103. [PMID: 31420054 PMCID: PMC6697973 DOI: 10.1186/s13052-019-0696-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of ‘wait and see’ for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used. Methods The study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0–14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. “Wait and see” approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results. Results We identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the “wait and see” approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics. Conclusions Despite guidance to use the ‘wait and see’ approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics. Electronic supplementary material The online version of this article (10.1186/s13052-019-0696-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Barbieri
- Department for Woman and Child Health, University of Padua, Padua, Italy.
| | - D Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy
| | - A Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | | | - G Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Pedianet Project, Padua, Italy
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8
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Elhajji FD, Al-Taani GM, Anani L, Al-Masri S, Abdalaziz H, Qabba'h SH, Al Bawab AQ, Scott M, Farren D, Gilmore F, Versporten A, Goossens H, Aldeyab MA. Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan. BMC Health Serv Res 2018; 18:849. [PMID: 30419895 PMCID: PMC6233602 DOI: 10.1186/s12913-018-3656-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background To assess antimicrobial prescribing in a Northern Ireland hospital (Antrim Area Hospital (AAH)) and compare them with those of a hospital in Jordan (Specialty Hospital). Methods Using the Global-PPS approach, the present study surveyed patients admitted to the hospital in 2015, the prescribed antibiotics, and a set of quality control indicators related to antibiotics. Results Ultimately, 444 and 112 inpatients in the AAH and the Specialty Hospital, respectively, were surveyed. For the medical group, 165 inpatients were prescribed 239 antibiotics in the AAH, while 44 patients in the Specialty Hospital were prescribed 65 antibiotics. In relation to the surgical group, 34 inpatients treated for infection were prescribed 66 antibiotics in the AAH, while 41 patients in the Specialty Hospital treated for infection were prescribed 56 antibiotics. For the medical patients, the most frequently prescribed antibiotics in the AAH were a combination of penicillins (18.8%) and penicillins with extended spectrum (18.8%). For the surgical patients, the most frequently prescribed antibiotics in the AAH were imidazole derivatives (24.2%). For the medical and surgical patients in the Specialty Hospital, the most frequently prescribed antibiotics were third-generation cephalosporins (26.2 and 37.5%, respectively). In medical patients, compliance to guidelines was 92.2% in the Specialty Hospital compared to 72.0% in the AAH (p < 0.001). In surgical patients, compliance to guidelines was 92.7% in the Specialty Hospital compared to 81.8% in the AAH (p = 0.012). Conclusions The present study highlighted differences in the utilisation of antimicrobials between two hospitals in two distinct regions and benchmarked antibiotic prescriptions across two hospitals.
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Affiliation(s)
- Feras Darwish Elhajji
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | | | - Lana Anani
- The Pharmacy Department, The Specialty Hospital, Amman, Jordan
| | - Sahar Al-Masri
- Quality & Medication Management, The Specialty Hospital, Amman, Jordan
| | - Haneen Abdalaziz
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | | | | | - Michael Scott
- Northern Health and Social Care Trust, Antrim, Ballymena, Northern Ireland, UK
| | - David Farren
- Northern Health and Social Care Trust, Antrim, Ballymena, Northern Ireland, UK
| | - Fiona Gilmore
- Northern Health and Social Care Trust, Antrim, Ballymena, Northern Ireland, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mamoon A Aldeyab
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Northern Ireland, UK
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Spicer KB, Green J, Dhada B. Hospital-acquired infections in paediatric medical wards at a tertiary hospital in KwaZulu-Natal, South Africa. Paediatr Int Child Health 2018; 38:53-59. [PMID: 28300495 DOI: 10.1080/20469047.2017.1299897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) impact care and costs in hospitals across the globe. There are minimal data on HAIs in sub-Saharan Africa and data specific to paediatrics are especially limited. OBJECTIVE To describe the incidence of HAIs in the paediatric medical units at Grey's Hospital, a tertiary government hospital in KwaZulu-Natal, South Africa. METHODS The Infection Prevention and Control (IPC) team collects data on all laboratory-confirmed infections, including from paediatric patients in two medical units (52 beds), the paediatric intensive/high-care unit (PICU, 8 beds) and the neonatal intensive care unit (NICU, 23 beds). HAIs are defined as infections: (i) not present (active or incubating) at the time of admission, and (ii) with onset >48 h after hospital admission. Daily patient statistics allow calculation of infections per 100 admissions and infections per 1000 patient days. RESULTS In the non-ICU setting, there were 7.1 and 7.0 HAIs per 100 admissions in 2013 and 2014, respectively. In the PICU, there were 20.4 and 15.3 HAIs per 100 admissions, while in the NICU there were 23.9 and 21.6 HAIs per 100 admissions in 2013 and 2014, respectively. In the non-ICU setting, there were 6.8 HAIs per 1000 patient days in both 2013 and 2014. In the PICU, there were 27.5 and 33.0 HAIs per 1000 patient days, while in the NICU, there were 20.3 and 21.5 HAIs per 1000 patient days in 2013 and 2014, respectively. CONCLUSION HAIs in non-ICU paediatric wards were consistent with a number of point-prevalence studies performed outside Africa (e.g. Canada, Russia, U.K.). Rates of HAIs in the ICUs were higher than rates reported from the International Nosocomial Infection Control Consortium, and were substantially higher than rates reported in the United States. HAIs are serious and important, especially in ICUs, and may be relatively neglected in low- and middle-income settings. Improved surveillance will allow the development and evaluation of targeted interventions to improve care of patients.
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Affiliation(s)
- Kevin B Spicer
- a Department of Health , Grey's Hospital , Pietermaritzburg , South Africa.,b Department of Paediatrics , Pietermaritzburg Metropolitan Hospitals Complex , Pietermaritzburg , South Africa.,c Department of Paediatrics , Nelson R. Mandela School of Medicine, University of KwaZulu-Natal , Durban , South Africa.,d Department of Pediatrics , Section of Infectious Diseases at the University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Jennifer Green
- a Department of Health , Grey's Hospital , Pietermaritzburg , South Africa
| | - Barnesh Dhada
- a Department of Health , Grey's Hospital , Pietermaritzburg , South Africa.,b Department of Paediatrics , Pietermaritzburg Metropolitan Hospitals Complex , Pietermaritzburg , South Africa.,c Department of Paediatrics , Nelson R. Mandela School of Medicine, University of KwaZulu-Natal , Durban , South Africa
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Goycochea-Valdivia WA, Moreno-Ramos F, Paño-Pardo JR, Aracil-Santos FJ, Baquero-Artigao F, del Rosal-Rabes T, Mellado-Peña MJ, Escosa-García L. Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription. Enferm Infecc Microbiol Clin 2017; 35:556-562. [DOI: 10.1016/j.eimc.2017.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/27/2022]
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Antibiotic Prescribing Pattern in Neonates of Seventeen Iranian Hospitals. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2017. [DOI: 10.5812/pedinfect.61630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Štefkovičová M, Litvová S, Meluš V, Krištúfková Z, Bražinová A. Point prevalence study of antimicrobial usage in acute care hospitals in the Slovak Republic. J Hosp Infect 2016; 93:403-9. [PMID: 27156010 DOI: 10.1016/j.jhin.2016.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antimicrobial use and resultant resistance is still increasing worldwide. Close monitoring and strict implementation of policies are important to tackle this issue. AIM To assess the use of antimicrobials in acute care hospitals in the Slovak Republic. METHODS Antimicrobial use was monitored as part of a point prevalence survey (PPS) of healthcare-associated infections. Surveillance was performed in 40 hospitals in the Slovak Republic according to the standardized methodology developed by the European Centre for Disease Prevention and Control. Data were collected according to a standard protocol. FINDINGS In total, 8397 patients in 40 Slovak hospitals were surveyed. Of these, 30.7% were receiving antibiotics at the time of the survey. In 630 cases, patients were receiving more than one antimicrobial agent. The prevalence of antimicrobial use was highest in intensive care units (54.3%). Antimicrobials were prescribed most frequently for treatment of community-acquired infections (48.1%) and healthcare-associated infections (11.4%). Surgical prophylaxis was the indication for 22.2% of all prescribed antimicrobials, and exceeded 24h in 81.5% of cases. The antimicrobials used most often were fluoroquinolones (20.9%), especially for non-surgical prophylaxis (26.8%) and treatment (21.9%). The antimicrobials prescribed most frequently for surgical prophylaxis were first-generation cephalosporins (23.0%), fluoroquinolones (14.7%) and second-generation cephalosporins (11.4%). The use of antimicrobials was higher in patients with invasive medical devices. CONCLUSION This study found excessive use of broad-spectrum antibiotics, prolonged surgical prophylaxis, frequent use of parenteral antibiotics and inadequate documentation of the indication for prescription. These findings present opportunities for improving the management of antimicrobials in Slovak hospitals.
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Affiliation(s)
- M Štefkovičová
- Regional Public Health Authority, Trenčín, Slovak Republic; Faculty of Health Care, Alexander Dubček University, Trenčín, Slovak Republic
| | - S Litvová
- Regional Public Health Authority, Trenčín, Slovak Republic
| | - V Meluš
- Faculty of Health Care, Alexander Dubček University, Trenčín, Slovak Republic
| | - Z Krištúfková
- Faculty of Public Health, Slovak Medical University, Bratislava, Slovak Republic
| | - A Bražinová
- Regional Public Health Authority, Trenčín, Slovak Republic; Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic.
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Implementation of Hospital’s Antibiotic Policy Decreases Antimicrobial Use in the General Pediatric Ward. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 857:67-74. [DOI: 10.1007/5584_2015_124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Henderson KL, Müller-Pebody B, Johnson AP, Wade A, Sharland M, Gilbert R. Community-acquired, healthcare-associated and hospital-acquired bloodstream infection definitions in children: a systematic review demonstrating inconsistent criteria. J Hosp Infect 2013; 85:94-105. [PMID: 24011498 DOI: 10.1016/j.jhin.2013.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/04/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Historically, bacterial infections were categorized as either community-acquired (CA) or hospital-acquired (HA). However, the CA/HA dichotomy no longer adequately reflects patterns of emerging healthcare-associated (HCA) infections in complex patients managed between hospital and the community. Studies trying to define this evolving epidemiology often excluded children. AIM To identify what criteria have been used to distinguish between CA, HCA and HA bloodstream infections (BSIs) in children, and the proportional distribution of CA, HCA and HA among total BSIs and by organism. METHODS We systematically reviewed published literature from PubMed, UK Department of Health and US Centers for Disease Control and Prevention websites. FINDINGS Results from 23 studies and the websites highlighted the use of inconsistent criteria. There were 13 and 15 criteria variations for CA and HA BSI respectively, although a 48h cut-off for cultures sampled post admission was most commonly reported. Five studies used variable clinical criteria to define HCA. The mean proportion of paediatric CA BSI in nine studies was 50%. Only four BSI organisms from five studies were predominantly CA (Streptococcus pneumoniae, Salmonella spp.) or HA (coagulase-negative staphylococci, Enterococcus spp.), whereas Pseudomonas spp., Klebsiella spp. and Enterobacter spp. did not clearly fit into either category. CONCLUSIONS Our study reveals inconsistent use of criteria, and a lack of evidence upon which to base them, to distinguish between CA, HCA and HA BSI in children. Criteria for CA, HCA and HA BSI need to be developed using population-based studies that consider patients' clinical characteristics, recent healthcare exposure as well as isolated organism species.
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Affiliation(s)
- K L Henderson
- Department of Healthcare-Associated Infections and Antimicrobial Resistance, Public Health England, London, UK; Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK.
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The antibiotic resistance and prescribing in European Children project: a neonatal and pediatric antimicrobial web-based point prevalence survey in 73 hospitals worldwide. Pediatr Infect Dis J 2013; 32:e242-53. [PMID: 23838740 DOI: 10.1097/inf.0b013e318286c612] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The neonatal and pediatric antimicrobial point prevalence survey (PPS) of the Antibiotic Resistance and Prescribing in European Children project (http://www.arpecproject.eu/) aims to standardize a method for surveillance of antimicrobial use in children and neonates admitted to the hospital within Europe. This article describes the audit criteria used and reports overall country-specific proportions of antimicrobial use. An analytical review presents methodologies on antimicrobial use. METHODS A 1-day PPS on antimicrobial use in hospitalized children was organized in September 2011, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Mandatory data were age, gender, (birth) weight, underlying diagnosis, antimicrobial agent, dose and indication for treatment. Data were entered through a web-based system for data-entry and reporting, based on the WebPPS program developed for the European Surveillance of Antimicrobial Consumption project. RESULTS There were 2760 and 1565 pediatric versus 1154 and 589 neonatal inpatients reported among 50 European (n = 14 countries) and 23 non-European hospitals (n = 9 countries), respectively. Overall, antibiotic pediatric and neonatal use was significantly higher in non-European (43.8%; 95% confidence interval [CI]: 41.3-46.3% and 39.4%; 95% CI: 35.5-43.4%) compared with that in European hospitals (35.4; 95% CI: 33.6-37.2% and 21.8%; 95% CI: 19.4-24.2%). Proportions of antibiotic use were highest in hematology/oncology wards (61.3%; 95% CI: 56.2-66.4%) and pediatric intensive care units (55.8%; 95% CI: 50.3-61.3%). CONCLUSIONS An Antibiotic Resistance and Prescribing in European Children standardized web-based method for a 1-day PPS was successfully developed and conducted in 73 hospitals worldwide. It offers a simple, feasible and sustainable way of data collection that can be used globally.
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Borrás Novell C, Hernández Bou S, García García JJ. [Prescribing of antibiotics in patients admitted from Emergency Departments: a multicenter study]. An Pediatr (Barc) 2012; 79:15-20. [PMID: 23084406 DOI: 10.1016/j.anpedi.2012.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 08/02/2012] [Accepted: 09/03/2012] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The infectious disease is the main source of care demand in Pediatric Emergency Departments (PED) and is a frequent cause of hospital admission with antibiotics. Our objectives are: 1) to determine the diseases that are seen in PED that required admission with antibiotics; 2) to determine the microbiological methods used and, 3) to analyze the characteristics of the indicated treatment. MATERIAL AND METHODS A prospective multicenter study was conducted in 22 Spanish hospitals. We included patients younger than 18 years seen in PED on day 14 of each month between June 2009 and May 2010 who required hospitalization with systemic antibiotics. Patients admitted to Intensive Care Unit were excluded. RESULTS There were 30,632 consultations in the PED during the study period. A total of 1,446 (4.7%) patients were hospitalized, 395 (27.3%) of them with antibiotics. Ninety-five patients (24.1%) had received antibiotics before admission. Three hundred twenty (81%) children underwent at least one microbiological test, with blood culture (69.9%) and urine culture (30.9%) being the most requested ones. The main diagnoses at admission were pneumonia (29.4%), urinary tract infection (15.4%), and fever without source (12.1%). Twenty five different antibiotics were prescribed, with cefotaxime (27.8%) and amoxicillin-clavulanate (23.4%) being the most prescribed ones. A single antibiotic was prescribed to 80.8% of patients, and parenteral administration was the most indicated (93.7%). CONCLUSIONS Antibiotic therapy was prescribed in one in every 4 patients who required admission to hospital. Pneumonia was the most common source. Blood culture was the most frequent microbiological test requested in the PED. A limited number of beta-lactam antibiotics represented the majority of antibiotic prescriptions.
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Affiliation(s)
- C Borrás Novell
- Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
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Zarb P, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): value of a point-prevalence survey of antimicrobial use across Europe. Drugs 2011; 71:745-55. [PMID: 21504250 DOI: 10.2165/11591180-000000000-00000] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
All 27 EU member states and another seven countries participate in the European Surveillance of Antimicrobial Consumption (ESAC) project. ESAC carried out three hospital point-prevalence surveys on antimicrobial use. Point-prevalence surveys linked antimicrobial use to indication and also assessed dosing using a standardized methodology for data collection and online data submission with feedback capability using a dedicated web-based tool. The objectives of the ESAC hospital point-prevalence surveys were to first determine the feasibility of a pan-European survey and identify targets for quality improvement. Hospitals were voluntarily selected by the lead national or hospital representatives for each country. The WHO Anatomical Therapeutic Chemical Classification of drugs was used for classification of antimicrobials. The three surveys were carried out during a maximum of 2 weeks in the second quarter of 2006, 2008 and 2009. Each department had to be surveyed in 1 day. All systemic antibacterials (J01), rifampicin (J04AB), oral vancomycin (A07AA) and oral/rectal metronidazole (P01AB) were the antimicrobials surveyed, including the prescribed regimen. The number of participating hospitals increased from 20 to 172 from 2006 to 2009. The patient demographics and indications for treatment were similar throughout the three point-prevalence surveys. 'Reason in notes' and 'surgical prophylaxis >24 hours' were also similar. Guideline compliance (51%) was only introduced in the 2009 point-prevalence survey, replacing 'sample for culture and sensitivity' (<50% in 2006 and 2008) since samples were either not taken or no information was available for the majority (>50%) of patients. The use of combination therapy, although exhibiting a wide range within each category, was related to hospital type, with teaching and tertiary hospitals having a significantly higher use of combination therapy (teaching : non-teaching hospitals [p < 0.0001]; and primary : tertiary hospitals [p < 0.0001]). Point-prevalence surveys are useful when time and resources do not allow for continuous surveillance. Repeated point-prevalence surveys within the same institution(s) can be used to monitor trends and effectiveness of antimicrobial-stewardship initiatives. Targets should be set as quality indicators for the individual hospital(s) and effectiveness of any intervention monitored through repeated point-prevalence surveys. Spin-off initiatives, such as the Antibiotic Resistance and Prescribing in European Children, and the European Centre for Disease Prevention and Control point-prevalence survey on healthcare-associated infections and antimicrobial use, will utilize adapted versions of WebPPS, the point-prevalence survey software developed by ESAC. WebPPS will also be made available for non-commercial use to third parties. Interest has been shown from three continents outside Europe, namely North America, Australia and Africa.
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Affiliation(s)
- Peter Zarb
- Infection Control Unit, Mater Dei Hospital, Msida, Malta
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Kieran JA, O'Doherty RG, Hudson BJ. ESAC point prevalence methodology to assess antimicrobial consumption and quality of prescribing in an Australian setting. Med J Aust 2011; 194:103-4. [DOI: 10.5694/j.1326-5377.2011.tb04183.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 11/02/2010] [Indexed: 11/17/2022]
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Amadeo B, Zarb P, Muller A, Drapier N, Vankerckhoven V, Rogues AM, Davey P, Goossens H. European Surveillance of Antibiotic Consumption (ESAC) point prevalence survey 2008: paediatric antimicrobial prescribing in 32 hospitals of 21 European countries. J Antimicrob Chemother 2010; 65:2247-52. [DOI: 10.1093/jac/dkq309] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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