Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections
Por:
Simó-Nebot S, Velasco E, Rios-Barnés M, López-Ramos MG, Manuel Monsonis Cabedo, Urrea M, Jordán-García I, Ricard Casadevall Llandrich, Ormazábal-Kirchner D, Cuadras-Palleja D, Tarrado X, Prat J, Sánchez E, Noguera-Julian A and Fortuny-Guasch C
Publicada:
1 ene 2021
Ahead of Print:
23 dic 2020
Resumen:
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.
Filiaciones:
Simó-Nebot S:
Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain
Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
Velasco E:
Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain
Rios-Barnés M:
Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain
López-Ramos MG:
Pharmacy Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Manuel Monsonis Cabedo:
Clinical Microbiology Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Urrea M:
Patient Safety Area-Infection Control Unit, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Jordán-García I:
Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Department of Paediatrics, University of Barcelona, 08007 Barcelona, Spain
Ricard Casadevall Llandrich:
Management Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Ormazábal-Kirchner D:
Computing Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Cuadras-Palleja D:
Statistics Department, Sant Joan de Déu Research Foundation, 08950 Barcelona, Spain
Tarrado X:
Paediatric Surgery Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Prat J:
Paediatric Surgery Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
Sánchez E:
Blanquerna School of Health Science, Ramon Llull University, 08022 Barcelona, Spain
Noguera-Julian A:
Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain
Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
Statistics Department, Sant Joan de Déu Research Foundation, 08950 Barcelona, Spain
Translational Research Network in Paediatric Infectious Diseases (RITIP), 28009 Madrid, Spain
Fortuny-Guasch C:
Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain
Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
Statistics Department, Sant Joan de Déu Research Foundation, 08950 Barcelona, Spain
Translational Research Network in Paediatric Infectious Diseases (RITIP), 28009 Madrid, Spain
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