Trends in paediatric inpatient antibiotic therapy in a secondary care setting

Abstract

There is growing attention for antimicrobial stewardship in paediatrics. Currently, little is known about secondary care antibiotic practice. We analysed trends in time with respect to inpatient antibiotic use in a secondary paediatric care setting. Total inpatient antibiotic consumption per year (2010-2015) and antibiotic prescriptions for urinary tract infection (UTI) and lower respiratory tract infection (LRTI) were analysed. Variables were total, antibiotic-specific, and intravenous days of therapy (DOT/100PD) and for UTI/LRTI treatment type, route and duration. Third-generation cephalosporin use decreased (DOT/100PD 11.6 in 2011 vs. 5.1 in 2015; p < 0.001); intravenous antibiotics were prescribed less often (p = 0.06). These findings were confirmed for the specific diseases: third-generation cephalosporin use decreased for both UTI (93% vs. 45%; p = 0.002) and LRTI (14% vs. 6%; p = 0.18); the duration of intravenous therapy decreased (UTI p = 0.02; LRTI p < 0.001). Median LRTI treatment duration was 9.2 days in 2008 and 6.6 in 2015 (p < 0.001); penicillin prescriptions were more narrow in spectrum (p = 0.02).

Conclusion: A decrease in third-generation cephalosporin use and intravenous route was identified. LRTI treatment was significantly shorter and more narrow in spectrum. This could be explained by awareness and interventions in the context of antimicrobial stewardship. A decrease in antibiotic use is also feasible and important in non-tertiary paediatric wards. What is Known: • Antimicrobial stewardship programmes are effective in reduction of total and broad-spectrum antibiotic use in tertiary paediatric hospitals • The majority of hospitalised paediatric patients are admitted at general, secondary care wards, often for infectious diseases What is New: • Antimicrobial stewardship interventions in secondary care are also effective in establishing a reduction in broad-spectrum antibiotic use, intravenous route and days on antibiotic therapy.

Keywords: Antibiotic stewardship; Antimicrobial therapy; Secondary care hospital; Third-generation cephalosporins.

Fig. 1

a Total DOT/100PD neonatology ward. DOT R² = 0.17 (p = 0.42). ATC groups are shown in different shades. b Total DOT/100PD paediatric ward. Total DOT R² = 2.7E−6 (p = 0.99). ATC groups are shown in different shades

Fig. 2

Empiric antibiotic therapy for urinary tract infection in 2008 and 2015. Cephalosporin prescriptions decrease significantly (chi-square, p < 0.01)

Fig. 3

Empiric antibiotic therapy for lower respiratory tract infection 2008 and 2015. Cephalosporin prescriptions did not decrease significantly (chi-square, p = 0.18); a difference in penicillin prescriptions was observed (increase in amoxicillin and decrease in amoxicillin/clavulanic acid prescriptions in 2015; p = 0.02)