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. 2024 Oct 30:11:20499361241282824.
doi: 10.1177/20499361241282824. eCollection 2024 Jan-Dec.

Impact of an antibiotic stewardship program on adherence to antibiotic prescription in children admitted with urinary tract infection

Giulia Brigadoi  1 , Cecilia Liberati  2 , Emelyne Gres  3 , Elisa Barbieri  2 , Elena Boreggio  4 , Sara Rossin  5 , Francesca Tirelli  5 , Francesca Tesser  4 , Lorenzo Chiusaroli  2 , Giulia Camilla Demarin  4 , Linda Maestri  4 , Carlo Giaquinto  2 , Liviana Da Dalt  5 , Silvia Bressan  5 , Daniele Donà  2
Affiliations

Impact of an antibiotic stewardship program on adherence to antibiotic prescription in children admitted with urinary tract infection

Giulia Brigadoi et al. Ther Adv Infect Dis. .

Abstract

Background: Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented.

Objective: The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center.

Design: This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021.

Methods: Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes.

Results: During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in E. coli strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria.

Conclusion: The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.

Keywords: adherence; antibiotics; antimicrobial stewardship program; children; urinary tract infection.

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Figures

Figure 1.
Figure 1.
(a) Adherence to the choice of empiric antibiotic therapy based on the internal guidelines for patients with UTI and (b) Adequacy of IV to oral switch based on the sensitivity results of urine culture. UTI, urinary tract infection.
Figure 2.
Figure 2.
Antibiotic prescription pattern: (a) antibiotic prescription prevalence rate stratified by years considering hospital antibiotic prescription (IV and oral) and (b) antibiotic prescription prevalence rate stratified by years considering oral antibiotic prescription after IV therapy.
Figure 3.
Figure 3.
River plot of antibiotic treatment switching. The rows of letters represent the prescriptions grouped by antibiotic classes/molecules in timely order from the upper part (first prescription) to the bottom part (last prescription, oral), and the colored lines show the connection with the following prescriptions in the same treatment episode.
Figure 4.
Figure 4.
Sensibility to antibiotics among E. coli strains isolated in patients admitted with UTI. UTI, urinary tract infection.
See this image and copyright information in PMC

References

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