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

Silvia Simó Nebot; María G López-Ramos; Eneritz Velasco-Arnaiz; Iolanda Jordan; Clàudia Fortuny; Antoni Noguera-Julian

doi:10.1016/j.eimc.2021.05.001

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

Enferm Infecc Microbiol Clin (Engl Ed). 2021 Jun 12:S0213-005X(21)00183-X. doi: 10.1016/j.eimc.2021.05.001. Online ahead of print.

[Article in English, Spanish]

Authors

Silvia Simó Nebot¹, María G López-Ramos², Eneritz Velasco-Arnaiz³, Iolanda Jordan⁴, Clàudia Fortuny⁵, Antoni Noguera-Julian⁶

Affiliations

¹ Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Centre for Biomedical Network Research on Epidemiology and Public Health, CIBERESP, Madrid, Spain.
² Pharmacy Department, Sant Joan de Déu Hospital, Barcelona, Spain.
³ Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
⁴ Centre for Biomedical Network Research on Epidemiology and Public Health, CIBERESP, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain; Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain.
⁵ Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Centre for Biomedical Network Research on Epidemiology and Public Health, CIBERESP, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.
⁶ Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Centre for Biomedical Network Research on Epidemiology and Public Health, CIBERESP, Madrid, Spain; Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain; Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain. Electronic address: ton@sjdhospitalbarcelona.org.

PMID: 34130886
DOI: 10.1016/j.eimc.2021.05.001

Abstract

Introduction: We aimed to describe antimicrobial use (AU) and quality of prescriptions (QP) in a 28-bed medical-surgical PICU of a European referral children's hospital during 2019.

Methods: AU data were expressed as days-of-therapy (DOT) over 100 days-present (DP) and as length-of-treatment (LOT). QP was based on monthly cross-sectional point-prevalence surveys. Length-of-stay (LOS), readmission rates (RR), and mortality rates (MR) were also collected.

Results: PICU AU accounted for 13.5% of the global hospital AU; the median PICU density of AU was 1.4 (IQR 1.3-1.5) times higher than that of the rest of the hospital areas. Antibacterials represented 88.5% of the overall AU, cefazolin and amoxicillin-clavulanate being the most used drugs. A high QP rate was observed (149/168 optimal, 88.9%), with room for improvement in prophylactic regimens and de-escalation of broad-spectrum regimens. LOT, LOS, RR, and MR remained stable.

Conclusions: PICU AU represented a major portion of the global hospital AU. Despite high QP rates, prophylactic and broad-spectrum antibiotic regimens were optimizable.

Keywords: Antimicrobial stewardship; Antimicrobial use; Duración de tratamiento; Length-of-treatment; Optimización de uso de antimicrobianos; PICU; Profilaxis; Prophylaxis; UCIP; Uso de antimicrobianos.