Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain-What Have We Learned?
Por:
Fresán-Ruiz E, Ana Carolina Izurieta Pacheco, Girona M, de Carlos-Vicente JC, Bustinza-Arriortua A, Slocker-Barrio M, Belda-Hofheinz S, Nieto-Moro M, Uriona-Tuma SM, Pinós-Tella L, Morteruel-Arizcuren E, Schuffelmann C, Peña-López Y, Bobillo-Perez S, Jordán-García I and On Behalf Of The Pediatric-Envin-Helics Study Group
Publicada:
1 jun 2022
Ahead of Print:
16 jun 2022
Categoría:
Pediatrics, perinatology and child health
Resumen:
Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (>= 1 month to <= 18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April-30 June) from 2014-2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014-2016 and 2017-2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p < 0.001) and healthcare-associated infections (HAIs) acquired in PICUs (p < 0.001). Antibiotics were empirical in 7720 infections (85.6%), with an increase in appropriate antibiotic indications during the second period (p < 0.001). The main indication for antibiotic adjustment was de-escalation, increasing in the second period (p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs.
Filiaciones:
Fresán-Ruiz E:
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Ana Carolina Izurieta Pacheco:
Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Girona M:
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
de Carlos-Vicente JC:
Pediatric Intensive Care Unit, Hospital Son Espases, 07120 Palma de Mallorca, Spain
Bustinza-Arriortua A:
Pediatric Intensive Care Unit, Hospital Gregorio Marañón, 28007 Madrid, Spain
Slocker-Barrio M:
Pediatric Intensive Care Unit, Hospital Gregorio Marañón, 28007 Madrid, Spain
Belda-Hofheinz S:
Pediatric Intensive Care Unit, Hospital 12 de Octubre, 28041 Madrid, Spain
Nieto-Moro M:
Pediatric Intensive Care Unit, Hospital Niño Jesús, 28009 Madrid, Spain
Uriona-Tuma SM:
Preventive Medicine and Public Health, ENVIN-HELICS Registry Administration, Hospital Vall d'Hebron, 08035 Barcelona, Spain
Pinós-Tella L:
Preventive Medicine and Public Health, ENVIN-HELICS Registry Administration, Hospital Vall d'Hebron, 08035 Barcelona, Spain
Morteruel-Arizcuren E:
Pediatric Intensive Care Unit, Hospital de Cruces, 48903 Bilbao, Spain
Schuffelmann C:
Pediatric Intensive Care Unit, Hospital La Paz, 28046 Madrid, Spain
Peña-López Y:
Pediatric Intensive Care Unit, Hospital Materno-Infantil Vall d'Hebron, 08035 Barcelona, Spain
Bobillo-Perez S:
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Jordán-García I:
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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