Impact of an antibiotic stewardship program on adherence to antibiotic prescription in children admitted with urinary tract infection.

IF 3.8 Q2 INFECTIOUS DISEASES Therapeutic Advances in Infectious Disease Pub Date : 2024-10-30 eCollection Date: 2024-01-01 DOI:10.1177/20499361241282824
Giulia Brigadoi, Cecilia Liberati, Emelyne Gres, Elisa Barbieri, Elena Boreggio, Sara Rossin, Francesca Tirelli, Francesca Tesser, Lorenzo Chiusaroli, Giulia Camilla Demarin, Linda Maestri, Carlo Giaquinto, Liviana Da Dalt, Silvia Bressan, Daniele Donà
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Abstract

Background: Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented.

Objective: The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center.

Design: This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021.

Methods: Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes.

Results: During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in E. coli strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria.

Conclusion: The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.

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抗生素管理计划对泌尿道感染患儿遵从抗生素处方的影响。
背景:尿路感染(UTI)是儿童最常见的细菌感染。病原体易感率的高变异性导致经验疗法和靶向疗法缺乏明确的指导原则。有鉴于此,需要实施本地微生物监测和因地制宜的管理干预措施:本研究旨在描述一项儿科抗菌药物管理计划对一家三级医院儿科普通病房 8 年来UTI 抗生素处方的影响结果:这项准实验研究在2015年至2022年期间进行,分别于2018年和2021年实施:从纳入患者的电子临床病历中检索人口统计学、临床、微生物学和治疗数据。主要结果是对当地经验疗法指南的遵守情况和靶向治疗的充分性。次要结果是评估住院期间和出院时按抗生素分层的抗生素处方模式,以及评估UTI发作的微生物学特征:在研究期间,儿科急症监护室(PACU)共收治了 7038 名患者,其中 264 人(3.7%)被纳入本研究。干预后,当地指南的遵守率最高,之后略有下降。在这 8 年中,头孢菌素的使用率一直很高,但由于观察到的微生物情况不断变化,研究期间的建议也随之改变。最近几年,对联合阿莫西林耐药的大肠杆菌菌株有所增加。口服二线药物的用量仍然很高,但考虑到耐药菌的流行,用量已经足够:抗菌药物消耗量的变化反映了UTI病原体耐药模式的变化,说明因地制宜、持之以恒地采取抗菌药物管理干预措施的重要性。
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来源期刊
CiteScore
5.30
自引率
8.80%
发文量
64
审稿时长
9 weeks
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