Use of multiple metrics to assess antibiotic use in Italian children's hospitals

Abstract

Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe point prevalence of antibiotic use by indication and patient characteristics, to evaluate DOTs, LOTs and PDDs, and to compare PDDs to DDDs, which assume average maintenance dose per day in adults. All children hospitalized on the days of the study were included. Trained personnel collected demographic and clinical data from patients' clinical records. We recorded information about antibiotics administered on the date of data collection, and in the previous 30 days of hospitalization. Of 810 patients, 380 (46.9%; CI 95%: 43.4-50.4) received one or more antibiotics; prevalence of use was 27.0% for prophylaxis (219/810), and 20.7% (168/810) for treatment. Overall, 587 drugs were issued to the 380 patients receiving antibiotics (1.5 antibiotic per patient). When considering treatments, DOT and LOT per 100 patient-days were 30.5 and 19.1, respectively, resulting in a DOT/LOT ratio of 1.6. PDDs increased with age and approached DDDs only in children aged ≥ 10 years; the ratio between PDDs estimated in children aged ≥ 10 years and in 0-11 month-old infants ranged from 2 for sulfamethoxazole and trimethoprim, to 25 for meropenem. Our results confirm that DOT, LOT and PDD are better alternatives to DDD in children.

Figure 1

Proportions of treatment by antibiotic drugs and indication of use. Only antibiotic drugs with a frequency of treatment > 1.0% are showed. J01CR: Combinations of penicillins, incl. beta-lactamase inhibitors; J01DD: third generation cephalosporins; J01GB: Other aminoglycosides; J01EE: Combinations of sulfonamides and trimethoprim; J01DH: Carbapenems; incl. derivatives; J01DB: First-generation cephalosporins; J01XA: Glycopeptide antibacterials; J01CA: Penicillins with extended spectrum; J01FA: Macrolides; J01XD: Imidazole derivatives; J01MA: Fluoroquinolones; J01DC: Second-generation cephalosporins.

Figure 2

DOT/100 patient days by antibiotic drugs provided for therapeutic purposes. Only antibiotic drugs with more than 1 DOT/100 patient days are shown in the graphic.