Original articleIdentifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescriptionDetección de prioridades para mejorar el uso hospitalario de antimicrobianos en pediatría mediante la evaluación transversal de la prevalencia y adecuación de la prescripción
Introduction
Inappropriate use of antimicrobials is linked to increasing antibiotic resistance due to important ecological effects.1, 2 It represents a major public health problem worldwide generating increasing morbidity, mortality and hospitalisation rates in recent years.1, 2, 3, 4 Resources invested in development of new antimicrobials will decrease, so proper use of those available must be a priority.5, 6, 7 Antimicrobial stewardship (AS) programmes that have been successfully implemented in adults have also been developed for paediatric populations.3, 7, 8, 9, 10, 11 Although the key principles for paediatric AS have been recently defined, paediatric patients have particular characteristics that hinder establishment of such programmes, as well as assessment of their impact.3
Benchmarking studies of antimicrobial use are fundamental to implement these programmes identifying opportunities for improvement,12 with corresponding impact interventions.1, 13 In this study, we aim to describe the prevalence of antimicrobial prescribing in a tertiary paediatric hospital and assess the appropriateness of antimicrobial use.
Section snippets
Setting
This was a cross-sectional descriptive study performed in a Spanish tertiary paediatric hospital with 256 hospitalisation beds distributed among different hospital areas: neonatology and neonatal intensive care unit (ICU), paediatric ICU, various medical and surgical wards, children with complex chronic conditions unit, departments responsible for five different types of solid organ transplantation and a haematology–oncology department that performs haematopoietic stem cell transplantation.
Ethics
The
Results
Total bed occupancy was 171 patients with a mean (±SD) age 4.3 ± 5.2 years. Overall, 85 patients (49.7%; 95% CI: 42.3–57.1) were receiving one or more antimicrobials, with PAP and AAP by ward summarised in Table 1. Reasons for admission were medical urgency for 58 patients (68.2%), scheduled medical admission for 12 (14.1%), scheduled surgical admissions for 11 (12.9%), and surgical emergency in 4 (4.7%) cases.
Globally, 113 infectious syndromes justifying treatment with antimicrobials were
Discussion
An extensive understanding of antimicrobial usage in paediatric settings is necessary prior to the development of AS. The intention of this study was to improve such understanding, in view of the limited existence of antimicrobial hospital-quality indicators of antibiotic prescription studies in children, mostly focused on the prevalence of prescription16, 17, 18, 19 and few assessing appropriateness of prescription.20, 21 Evaluating antimicrobial consumption by ward, our total PAP surpasses
Funding
No specific funding was received for this article.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
We would like to thank Keith Veitch for the English language editing in the manuscript.
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