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Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain-What Have We Learned?
Elena Fresán-Ruiz1,2, Ana Carolina Izurieta-Pacheco3, Mònica Girona-Alarcón1,2
1Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain.
Insights
Implementing antibiotic stewardship programs (ASPs) in pediatric intensive care units (PICUs) significantly improved appropriate antibiotic use and adjustment, reducing unnecessary antibiotic days for infections.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Antibiotic misuse in pediatric intensive care units (PICUs) is a significant concern, contributing to antimicrobial resistance, adverse effects, and increased mortality.
- Effective antibiotic stewardship programs (ASPs) are crucial for optimizing antibiotic use in critical care settings.
Purpose of the Study:
- To evaluate the impact of ASP implementation on antibiotic prescribing patterns and outcomes in Spanish PICUs.
- To compare antibiotic use and management strategies before and after the widespread adoption of ASPs.
Main Methods:
- A multicenter, prospective study involving 11,260 critically ill pediatric patients across 26 Spanish PICUs from 2014-2019.
- Analysis divided into two periods: 2014-2016 (pre-ASP) and 2017-2019 (post-ASP implementation).
- Comparison of antibiotic prescriptions, days without antibiotics, empirical use, and de-escalation strategies.
Main Results:
- Significant increase in days without antibiotics for both community-acquired and healthcare-associated infections (p < 0.001) after ASP implementation.
- Higher rate of appropriate antibiotic indications in the second period (p < 0.001).
- De-escalation became the primary antibiotic adjustment strategy, increasing significantly (p = 0.045).
Conclusions:
- Implementation of ASPs in PICUs led to a significant improvement in appropriate antibiotic use and adjustment.
- These findings highlight the effectiveness of ASPs in optimizing antibiotic therapy and potentially mitigating resistance in critically ill children.
Abstract:
Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April−30 June) from 2014−2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014−2016 and 2017−2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p < 0.001) and healthcare-associated infections (HAIs) acquired in PICUs (p < 0.001). Antibiotics were empirical in 7720 infections (85.6%), with an increase in appropriate antibiotic indications during the second period (p < 0.001). The main indication for antibiotic adjustment was de-escalation, increasing in the second period (p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs.
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