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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across
Myriam Gharbi1, Katja Doerholt2, Stefania Vergnano3
1NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection-Department of Primary Care and Public Health, Imperial College London, London, UK.
Insights
Antibiotic prescribing varies widely in UK hospitals for children. This study provides a baseline for improving antibiotic use in pediatric care, aligning with national antimicrobial resistance goals.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Public Health
Background:
- National Health Service England's CQUIN AMR initiative targets reduced antibiotic consumption in secondary care.
- Lack of baseline data on antibiotic use in hospitalised children hinders improvement efforts.
- Understanding current prescribing patterns is crucial for effective antimicrobial stewardship.
Purpose of the Study:
- To describe, compare, and explain antibiotic prescription patterns in UK paediatric units.
- To establish a baseline for antibiotic prescribing in hospitalised children.
- To inform future improvements aligned with CQUIN AMR guidance.
Main Methods:
- A cross-sectional point prevalence survey (PPS) was conducted in 61 UK paediatric units.
- The study followed the standardised protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project.
- Inclusion criteria: all inpatients under 18 years old, excluding neonates.
Main Results:
- 40.9% of 3047 hospitalised children were on antibiotics; prevalence varied between hospital types.
- Antibiotic prophylaxis accounted for approximately 25% of antibiotic therapy.
- General paediatrics units showed high prescribing rates of critical broad-spectrum antibiotics like carbapenems.
Conclusions:
- This study establishes a robust baseline for antibiotic prescribing in hospitalised children in the UK.
- Repeated PPS linked with resistance data is essential for antimicrobial stewardship strategies.
- Addressing suboptimal antibiotic use in hospitalised children requires ongoing monitoring and targeted interventions.
Background:
The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.
Methods:
We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.
Results:
A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.
Conclusions:
We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.
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