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Published on: August 30, 2018
Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance
Wallis Rudnick1, John Conly2,3, Daniel J G Thirion4,5
1Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada.
Insights
This study established benchmark antimicrobial use (AMU) rates for Canadian pediatric inpatients. Overall AMU was 481 days of therapy per 1000 patient days, with significant variation across hospitals and units.
Area of Science:
- Infectious Diseases
- Pediatric Healthcare
- Pharmacology
Background:
- Antimicrobial resistance poses a significant global health threat.
- Existing antimicrobial use (AMU) benchmarks primarily focus on adult populations.
- Limited data exists on AMU patterns in pediatric inpatients.
Purpose of the Study:
- To establish benchmark rates of antimicrobial use (AMU) in Canadian pediatric inpatients.
- To provide data for antimicrobial stewardship initiatives in pediatric care.
- To identify variations in AMU across different pediatric hospital units.
Main Methods:
- Collected annual AMU data from nine Canadian acute-care hospitals for 2017-2018.
- Included all systemic antimicrobials used in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and non-ICU wards.
- Analyzed data using days of therapy (DOT) per 1000 patient days (DOT/1000pd).
Main Results:
- Overall pediatric AMU was 481 DOT/1000pd, with high inter-hospital variability.
- AMU was highest in PICUs (784 DOT/1000pd), followed by non-ICU wards (494 DOT/1000pd) and NICUs (333 DOT/1000pd).
- Commonly used antimicrobials varied by unit, with cefazolin, ceftriaxone, and piperacillin-tazobactam frequent in non-ICU and PICU settings, and ampicillin, gentamicin/tobramycin, and cefotaxime in NICUs.
Conclusions:
- This study provides the most extensive dataset on pediatric inpatient AMU in Canada to date.
- Established benchmark AMU rates of 481 DOT/1000pd for pediatric inpatients.
- Highlights the need for national surveillance of pediatric AMU to inform antimicrobial stewardship programs.
Background:
Antimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals.
Methods:
Acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd).
Results:
Nine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409-554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd).
Conclusions:
This study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.
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