Measuring antimicrobial use in hospitalized patients: a systematic review of available measures applicable to...

Area of Science:

• Healthcare Epidemiology
• Infectious Diseases
• Pediatric Health

Background:

• Accurate surveillance of antimicrobial usage is critical for combating antimicrobial resistance.
• Existing measures for tracking antimicrobial consumption in hospital settings, particularly those including pediatric populations, lack definitive validation.
• Understanding the optimal metric is essential for effective antimicrobial stewardship programs.

Purpose of the Study:

• To systematically review and compare existing measures of antimicrobial use applied in settings with pediatric inpatients.
• To identify and define various antimicrobial usage metrics used in literature.
• To provide a foundation for selecting the most effective measure for surveillance and resistance prediction.

Main Methods:

• Systematic literature search of MEDLINE, EMBASE, CINAHL, and LILACS (1975-2011) and citation tracking.
• Inclusion of cohort studies and repeated point-prevalence studies involving hospitalized pediatric patients.
• Independent data extraction by two reviewers on study characteristics and antimicrobial measure comparisons.

Main Results:

• Seventy-nine studies met selection criteria, identifying 26 distinct antimicrobial usage measures.
• The most common measures were defined daily doses (DDD)/patient-days and exposed patients/patients.
• Limited quantitative comparisons showed correlations between different metrics, with doses/patient-days showing a stronger link to resistance rates.

Conclusions:

• The optimal measure for antimicrobial use surveillance that best predicts antimicrobial resistance has not yet been identified.
• Further research is necessary to establish evidence-based recommendations for antimicrobial usage metrics.
• The findings highlight the need for standardized and validated measures in pediatric and general hospital settings.