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. 2022 Jun 16;9(6):902.
doi: 10.3390/children9060902.

Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain-What Have We Learned?

Elena Fresán-Ruiz  1   2 , Ana Carolina Izurieta-Pacheco  3 , Mònica Girona-Alarcón  1   2 , Juan Carlos de Carlos-Vicente  4 , Amaya Bustinza-Arriortua  5 , María Slocker-Barrio  5 , Sylvia Belda-Hofheinz  6 , Montserrat Nieto-Moro  7 , Sonia María Uriona-Tuma  8 , Laia Pinós-Tella  8 , Elvira Morteruel-Arizcuren  9 , Cristina Schuffelmann  10 , Yolanda Peña-López  11 , Sara Bobillo-Pérez  1   2 , Iolanda Jordan  1   12 , On Behalf Of The Pediatric-Envin-Helics Study Group
Affiliations

Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain-What Have We Learned?

Elena Fresán-Ruiz et al. Children (Basel). .

Abstract

Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April−30 June) from 2014−2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014−2016 and 2017−2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p < 0.001) and healthcare-associated infections (HAIs) acquired in PICUs (p < 0.001). Antibiotics were empirical in 7720 infections (85.6%), with an increase in appropriate antibiotic indications during the second period (p < 0.001). The main indication for antibiotic adjustment was de-escalation, increasing in the second period (p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs.

Keywords: antibiotics; antimicrobial stewardship; children; de-escalation; early suspension; pediatric intensive care; resistant microorganisms.

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Conflict of interest statement

The authors declare no conflict of interest. The funding entities had no role in the design of the study; the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Evolution of the ratio for the number of antibiotics per patient prescribed antibiotics. Comparison of proportions between 2014–2016 vs. 2017–2019 expressed as p-values.
Figure 2
Figure 2
Representation of the evolution of different ratios regarding the use of antibiotics. Comparison of proportions between 2014–2016 vs. 2017–2019 expressed as p-values.
Figure 3
Figure 3
Evolution over time of the global use of meropenem (meropenem with respect to the global antibiotic indication) and the use of meropenem for suspected healthcare-associated infection (prescription of meropenem with respect to the indication of antibiotics for suspected healthcare-associated infection).
Figure 4
Figure 4
Regarding empirical antibiotic prescriptions, Plot 1 compares the accuracy of the antibiotic indications between the two time periods (2014–2016 vs. 2017–2019). It includes the proportion of appropriate antibiotic indications, inappropriate indications, and cases with negative cultures. Plot 2 represents the evolution over time of the need for antibiotics to be adjusted and suspended early in empirical indications.
Figure 5
Figure 5
Representation of the evolution of the different reasons for switching antibiotics in those patients who required an adjustment of their antibiotic therapy.
See this image and copyright information in PMC

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