Impact and quality of antimicrobial use in a referral pediatric intensive care unit

Area of Science:

• Pediatric critical care medicine
• Infectious disease epidemiology
• Antimicrobial stewardship

Background:

• Antimicrobial use (AU) and prescription quality (QP) are critical in pediatric intensive care units (PICUs).
• Understanding AU and QP patterns is essential for optimizing antimicrobial stewardship programs.
• This study focused on a 28-bed medical-surgical PICU in a European children's hospital in 2019.

Purpose of the Study:

• To describe antimicrobial use (AU) and quality of prescriptions (QP) in a pediatric intensive care unit (PICU).
• To analyze antimicrobial prescribing patterns and identify areas for improvement in a European children's hospital PICU.
• To evaluate the relationship between antimicrobial use, prescription quality, and patient outcomes.

Main Methods:

• Antimicrobial use (AU) quantified using days-of-therapy (DOT) per 100 days-present (DP) and length-of-treatment (LOT).
• Prescription quality (QP) assessed via monthly cross-sectional point-prevalence surveys.
• Patient outcomes including length-of-stay (LOS), readmission rates (RR), and mortality rates (MR) were collected.

Main Results:

• PICU antimicrobial use constituted 13.5% of total hospital AU, with a median density 1.4 times higher than other areas.
• Antibacterial agents comprised 88.5% of AU, with cefazolin and amoxicillin-clavulanate being most frequent.
• A high overall prescription quality rate of 88.9% was observed, though prophylactic and broad-spectrum regimens require optimization.

Conclusions:

• Antimicrobial use in the PICU is substantial relative to the entire hospital.
• Despite a high rate of quality prescriptions, opportunities exist to refine prophylactic and broad-spectrum antibiotic strategies.
• Continuous monitoring and targeted interventions are necessary for effective antimicrobial stewardship in PICUs.