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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Antimicrobial Stewardship Programs in PICU Settings: A Systematic Review.

Elisavet Chorafa¹, Vasiliki Komatsiouli¹, Elias Iosifidis¹

¹Infectious Diseases Unit, Third Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|August 24, 2022

Summary

Antimicrobial stewardship programs (ASPs) are crucial for combating antimicrobial resistance. This review found limited ASP implementation in pediatric intensive care units (PICUs), with most programs using multimodal strategies but not fully adhering to recommendations.

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Area of Science:

Infectious Diseases
Critical Care Medicine
Public Health

Background:

Antimicrobial resistance (AMR) poses a significant global health threat, necessitating effective antimicrobial stewardship programs (ASPs).
Pediatric intensive care units (PICUs) are critical settings where ASPs are vital for managing antimicrobial use and preventing AMR.
A systematic review was conducted to analyze the current landscape of ASPs in PICUs.

Approach:

A systematic literature search was performed on PubMed and Scopus for studies published between January 1, 2007, and December 31, 2020.
Studies focusing on antimicrobial stewardship interventions specifically within PICUs were included, with data extracted on intervention strategies, team structure, implementation, and outcomes.
Risk of bias was assessed using the Cochrane Risk-of-Bias tool for non-randomized studies.

Key Points:

Eleven studies focused on PICU-dedicated ASPs, with most employing multimodal interventions combining strategies like audit with feedback and clinical practice guidelines.
Multidisciplinary teams were common, and some interventions incorporated behavior change techniques.
Outcomes assessed included antibiotic consumption, cost, resistance, length of hospitalization, and mortality, though not all were reported in every study.

Conclusions:

The prevalence of comprehensive ASPs in PICUs remains limited, with many programs not fully aligning with existing recommendations.
Further development and adherence to ASP guidelines in PICUs are essential for effective antimicrobial resistance containment.