Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018

Wallis Rudnick; John Conly; Daniel J G Thirion; Kelly Choi; Linda Pelude; Joelle Cayen; John Bautista; Lizanne Beique; Jeannette L Comeau; Bruce Dalton; Johan Delport; Rita Dhami; Joanne Embree; Yannick Émond; Gerald Evans; Charles Frenette; Susan Fryters; Jennifer Happe; Kevin Katz; Pamela Kibsey; Joanne M Langley; Bonita E Lee; Marie-Astrid Lefebvre; Jerome A Leis; Allison McGeer; Susan McKenna; Heather L Neville; Kathryn Slayter; Kathryn N Suh; Alena Tse-Chang; Karl Weiss; Michelle Science; Canadian Nosocomial Infection Surveillance Program

doi:10.1186/s13756-023-01219-x

Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018

Antimicrob Resist Infect Control. 2023 Apr 18;12(1):35. doi: 10.1186/s13756-023-01219-x.

Authors

Wallis Rudnick¹, John Conly^{2

3}, Daniel J G Thirion^{4

5}, Kelly Choi¹, Linda Pelude¹, Joelle Cayen¹, John Bautista⁶, Lizanne Beique¹, Jeannette L Comeau⁷, Bruce Dalton⁸, Johan Delport⁹, Rita Dhami^{9

10

11}, Joanne Embree^{12

13

14}, Yannick Émond¹⁵, Gerald Evans¹⁶, Charles Frenette⁵, Susan Fryters¹⁷, Jennifer Happe¹⁸, Kevin Katz¹⁹, Pamela Kibsey²⁰, Joanne M Langley^{21

7}, Bonita E Lee^{22

23}, Marie-Astrid Lefebvre⁵, Jerome A Leis^{24

25}, Allison McGeer^{26

27

28}, Susan McKenna¹⁶, Heather L Neville²⁹, Kathryn Slayter²¹, Kathryn N Suh³⁰, Alena Tse-Chang^{22

23}, Karl Weiss³¹, Michelle Science³²; Canadian Nosocomial Infection Surveillance Program

Affiliations

¹ Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada.
² University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
³ Foothills Medical Centre, Alberta Health Services, 3330 Hospital Dr. NW, Calgary, AB, T2N 2T9, Canada.
⁴ Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada.
⁵ McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada.
⁶ Central Newfoundland Regional Health Centre, 50 Union, Grand Falls-Windsor, NL, A2A 2E1, Canada.
⁷ Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada.
⁸ Alberta Health Services, 1620 29 St NW, Calgary, AB, T2N 4L7, Canada.
⁹ London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.
¹⁰ University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
¹¹ University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
¹² University of Manitoba, Winnipeg, MB, R3T 2N2, Canada.
¹³ Shared Health Manitoba, Winnipeg, MB, R3T 2N2, Canada.
¹⁴ Children's Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB, R3E 0Z3, Canada.
¹⁵ Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada.
¹⁶ Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
¹⁷ Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.
¹⁸ Infection Prevention and Control Canada, Red Deer, AB, T4N 6R2, Canada.
¹⁹ North York General Hospital, 4001 Leslie St, North York, ON, M2K 1E1, Canada.
²⁰ Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada.
²¹ IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada.
²² Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada.
²³ University of Alberta, Edmonton, AB, T6G 2R7, Canada.
²⁴ Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.
²⁵ Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
²⁶ Sinai Health System, 600 University Ave, Toronto, ON, M5G 1X5, Canada.
²⁷ University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada.
²⁸ Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
²⁹ Nova Scotia Health, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada.
³⁰ The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
³¹ SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
³² SickKids, 555 University Ave, Toronto, ON, M5G 1X8, Canada. michelle.science@sickkids.ca.

Abstract

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.

Keywords: Antimicrobial use; Hospital; Paediatric; Surveillance.

MeSH terms

Adult
Anti-Infective Agents*
Canada / epidemiology
Cefazolin
Ceftriaxone
Child
Cross Infection* / drug therapy
Cross Infection* / epidemiology
Cross Infection* / prevention & control
Hospitals
Humans
Infant, Newborn
Inpatients
Piperacillin
Tazobactam

Substances

Ceftriaxone
Cefazolin
Anti-Infective Agents
Piperacillin
Tazobactam