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Use of antibiotics in pediatric intensive care and potential savings
J E Fischer1, M Ramser, S Fanconi
1Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Zurich, Switzerland. joachim.fischer@kispi.unizh.ch
Insights
Reducing antibiotic use in intensive care units is crucial. This study found that targeting suspected ventilator-associated pneumonia and limiting extended prophylaxis can significantly decrease antibiotic exposure in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Antibiotic stewardship
Background:
- Minimizing unnecessary antibiotic prescriptions is a key objective in healthcare settings.
- Patient mix and unit characteristics necessitate site-specific antibiotic reduction targets.
- Developing effective models for antibiotic use reduction is essential.
Purpose of the Study:
- To present a model for identifying site-specific targets to reduce antibiotic prescriptions.
- To analyze antibiotic utilization patterns in a neonatal and pediatric intensive care unit.
- To determine the primary drivers of antibiotic exposure in critically ill children.
Main Methods:
- An observational cohort study was conducted in a tertiary, multidisciplinary neonatal and pediatric intensive care unit.
- Data on 456 newborns and children admitted between September 1998 and March 1999 were analyzed.
- Daily antibiotic prescriptions and indications were recorded, with post-treatment assessment for infection presence.
Main Results:
- Over 56% of patients received antibiotics, totaling 1815 exposure days.
- Antibiotics were prescribed for prophylaxis (28%) and suspected infections (72%).
- Ventilator-associated pneumonia and suspected sepsis were major indications, but 40% of treatment days were for non-bacterial or viral infections.
Conclusions:
- The largest potential for antibiotic reduction lies in improving the diagnosis of suspected ventilator-associated pneumonia.
- Curtailing extended prophylactic antibiotic use is another key strategy for reduction.
- Site-specific data analysis is vital for guiding antibiotic stewardship efforts.
Objective:
Minimizing unwarranted prescription of antibiotics remains an important objective. Because of the heterogeneity between units regarding patient mix and other characteristics, site-specific targets for reduction must be identified. Here we present a model to address the issue by means of an observational cohort study.
Setting:
A tertiary, multidisciplinary, neonatal, and pediatric intensive care unit of a university teaching hospital.
Patients:
All newborns and children present in the unit (n = 456) between September 1998 and March 1999. Reasons for admission included postoperative care after cardiac surgery, major neonatal or pediatric surgery, severe trauma, and medical conditions requiring critical care.
Methods:
Daily recording of antibiotics given and of indications for initiation. After discontinuation, each treatment episode was assessed as to the presence or absence of infection.
Results:
Of the 456 patients 258 (56.6%) received systemic antibiotics, amounting to 1815 exposure days (54.6%) during 3322 hospitalization days. Of these, 512 (28%) were prescribed as prophylaxis and 1303 for suspected infection. Treatment for suspected ventilator-associated pneumonia accounted for 616 (47%) of 1303 treatment days and suspected sepsis for 255 days (20%). Patients were classified as having no infection or viral infection during 552 (40%) treatment days. The average weekly exposure rate in the unit varied considerably during the 29-week study period (range: 40-77/100 hospitalization days). Patient characteristics did not explain this variation.
Conclusion:
In this unit the largest reduction in antibiotic treatment would result from measures assisting suspected ventilator-associated pneumonia to be ruled out and from curtailing extended prophylaxis.