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Strategies to control antibiotic resistance: results from a survey in Italian children's hospitals
M L Ciofi Degli Atti1, C D'Amore1, C Gagliotti2
1Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Italian children's hospitals have infection control measures but need to improve multi-drug resistant bacteria screening and antimicrobial stewardship programs. Enhancing antibiotic prescribing policies is crucial for better resistance control.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Public Health
Background:
- Antimicrobial stewardship and infection control programs are key to combating multi-drug resistant bacteria in hospitals.
- Controlling antibiotic resistance is a global health priority, especially in vulnerable pediatric populations.
Purpose of the Study:
- To assess the strategies employed by Italian children's hospitals to control antibiotic resistance.
- To identify areas for improvement in infection control and antimicrobial stewardship in pediatric care settings.
Main Methods:
- A cross-sectional, multicenter study involving four tertiary Italian children's hospitals.
- Data collected via a self-administered online questionnaire on infection control, multi-drug resistant bacteria management, and antibiotic prescribing policies.
- Questionnaires focused on policies for hospital-acquired infections, multi-drug resistant bacteria, and antimicrobial stewardship programs, with data compiled in 2016.
Main Results:
- All participating hospitals had infection control committees and standard procedures for hygiene, isolation, and disinfection.
- Screening for multi-drug resistant bacteria colonization was implemented in selected units, with contact precautions for colonized patients.
- Policies for surgical prophylaxis were universal, but varied for medical prophylaxis and treatment; antimicrobial stewardship programs and specific antibiotic prescribing guidelines were not consistently applied.
Conclusions:
- Italian children's hospitals demonstrate a foundational level of infection control but require enhancements in multi-drug resistant bacteria screening protocols.
- Strengthening antimicrobial stewardship programs and standardizing antibiotic prescribing policies for therapeutic use and prophylaxis are essential for effective resistance management.
- Targeted interventions are needed to improve the comprehensive control of antibiotic resistance in pediatric hospital settings.
Background:
Antimicrobial stewardship programs and comprehensive infection control programs represent the main strategies to limit the emergence and transmission of multi-drug resistant bacteria in hospital settings. The purpose of this study was to describe strategies implemented in Italian children's hospitals for controlling antibiotic resistance.
Study Design:
Cross sectional multicenter study.
Methods:
Four tertiary care Italian children's hospitals were invited to participate in a survey aimed at collecting information on activities implemented as of December 2015 using a self-administered online questionnaire. The questionnaire was divided in three sections focalizing on: i) policies for prevention and control of hospital-acquired infection, ii) prevention and control of multi-drug resistant bacteria, and iii) antibiotic prescribing policies and Antimicrobial stewardship programs. Questionnaires were compiled between May and July 2016.
Results:
All hospitals had multidisciplinary infection control committee, procedures on hand hygiene, isolation measures, disinfection/sterilization, waste disposal and prevention on infections associated to invasive procedures. All sites screened patients for multi-drug resistant bacteria colonization in selected units, and adopted contact precautions for colonized patients. Screening during hospitalization, or in case of infections in the same ward were not universally implemented. All hospitals had policies on surgical prophylaxis, while policies on medical prophylaxis and treatment of bacterial infections varied among sites. Two sites recommended to review the appropriateness of antibiotic prescribing after 48-72 hours and one recommended de-escalation therapy.
Conclusions:
This study highlighted several areas of improvement, such as actions for screening patients in case of occurrence of multi-drug resistant bacteria, antimicrobial stewardship programs and implementation of policies targeting antibiotic prescriptions for therapeutic purposes and medical prophylaxis.
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