Antibiotic use in pediatric acute care hospitals: an analysis of antibiotic consumption data from Germany, 2013-2020

Abstract

Background: Antimicrobial stewardship (AMS) programs are effective tools for improving antibiotic prescription quality. Their implementation requires the regular surveillance of antibiotic consumption at the patient and institutional level. Our study captured and analyzed antibiotic consumption density (ACD) for hospitalized pediatric patients.

Method: We collected antibacterial drug consumption data for 2020 from hospital pharmacies at 113 pediatric departments of acute care hospitals in Germany. ACD was calculated as defined daily dose (DDD, WHO/ATC Index 2019) per 100 patient days (pd). In addition, we analyzed the trends in antibiotic use during 2013-2020.

Results: In 2020, median ACD across all participating hospitals was 26.7 DDD/100 pd, (range: 10.1-79.2 DDD/100 pd). It was higher at university vs. non-university hospitals (38.6 vs. 25.2 DDD/100 pd, p < 0.0001). The highest use densities were seen on oncology wards and intensive care units at university hospitals (67.3 vs. 38.4 DDD/100 pd). During 2013-2020, overall ACD declined (- 10%) and cephalosporin prescriptions also decreased (- 36%). In 2020, cephalosporins nevertheless remained the most commonly dispensed class of antibiotics. Interhospital variability in cephalosporin/penicillin ratio was substantial. Antibiotics belonging to WHO AWaRe "Watch" and "Reserve" categories, including broad-spectrum penicillins (+ 31%), linezolid (+ 121%), and glycopeptides (+ 43%), increased over time.

Conclusion: Significant heterogeneity in ACD and prescription of different antibiotic classes as well as high prescription rates for cephalosporins and an increased use of reserve antibiotics indicate improvable antibiotic prescribing quality. AMS programs should urgently prioritize these issues to reduce antimicrobial resistance.

Keywords: Antibiotic consumption; Defined daily dose; Pediatric hospitals; Pharmacy prescription data; Recommended daily dose.

Fig. 1

Antibiotic consumption density (in DDD/100 patient days) of specific antibiotic classes at 113 pediatric hospitals of different sizes and categories. A Hospitals with < 400 beds, B hospitals with 400–800 beds, C hospitals with > 800 beds. University hospitals are marked with a asterisk. Data are for the year 2020. BLI, beta-lactamase inhibitors

Fig. 2

Use of antibiotic classes in patients in non-university and university hospitals (all wards) (A) and on regular hospital wards vs. ICU and oncologic wards of university hospitals (B) as a proportion of the median antibiotic consumption density (in % DDD) in the respective stratum. Data for the year 2020. BLI, beta-lactamase inhibitors

Fig. 3

Percentage of antibiotic use in children according to the WHO AWaRe classification for pediatric hospitals with acute care wards (A) and as individual hospitals (B). Data for the year 2020

Fig. 4

Antibiotic consumption density of penicillins and cephalosporins (DDD/100pd) for the time period 2013–2020

Fig. 5

Overall antibiotic consumption density and consumption of single antibiotic classes as usage evolved during the course of the surveillance period (2013–2020) at university hospitals (A) and non-university hospitals (B). Data shown as a regression coefficient representing the change in ACD per year with 2.5%/97.5% confidence intervals. Statistics were calculated using a linear mixed model adjusted for hospital service type