Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 6;6(6):dlae181.
doi: 10.1093/jacamr/dlae181. eCollection 2024 Dec.

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years

Giulia Brigadoi  1 , Emelyne Gres  2 , Elisa Barbieri  1 , Cecilia Liberati  1 , Sara Rossin  3 , Lorenzo Chiusaroli  1 , Giulia Camilla Demarin  4 , Francesca Tesser  4 , Linda Maestri  4 , Francesca Tirelli  5 , Elena Carrara  6 , Evelina Tacconelli  6 , Silvia Bressan  3 , Carlo Giaquinto  1 , Liviana Da Dalt  3 , Daniele Donà  1
Affiliations

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years

Giulia Brigadoi et al. JAC Antimicrob Resist. .

Abstract

Background: Antibiotics are the most prescribed drugs for children worldwide, but overuse and misuse have led to an increase in antibiotic resistance. Antimicrobial stewardship programmes (ASPs) have proven feasible in reducing inappropriate antimicrobial use. The study aimed at evaluating the impact and sustainability of an ASP with multiple interventions over 8 years.

Methods: This quasi-experimental study was conducted between 2014 and 2022 in the paediatric acute care unit of Padua University Hospital. Demographic and clinical data were retrieved from the electronic clinical records. Daily prescriptions were collected and analysed based on the AWaRe classification and using days of therapy (DOT) out of 1000 patient days (DOT/1000PDs). The primary outcome was to assess the change in overall antibiotic consumption and of access and watch antibiotics, stratifying patients with and without comorbidities. Trends in antibiotic consumption (DOTs/1000PD) were assessed using joinpoint regression analysis.

Findings: A total of 3118 children were included. Total antibiotic consumption remained stable and low in patients without comorbidities, ∼300 DOT/1000PDs, whereas a statistically significant constant reduction was observed in children with comorbidities, from almost 500 DOT/1000PPDs to <400 DOT/1000PDs. Access consumption increased in both groups of patients, whereas watch consumption constantly decreased, although statistically significant only in children with comorbidities.

Interpretation: Implementing a multistep ASP has proven feasible and sustainable in improving antibiotic prescriptions for previously healthy and fragile children. All the implemented interventions were low cost, and with efficient use of resources, ensuring an ASP that was effective, practical, and easily replicable and implementable in various healthcare settings.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
The sequential intervention of the multifaceted ASP through the 8 years. More transparent colours represent the COVID-19 period when many educational activities were either reduced or conducted remotely, and the presence of infectious disease physician at ward rounds was reduced due to pandemic-related restrictions. CPs, clinical pathways; AOM, acute otitis media; PACU, paediatric acute care unit.
Figure 2.
Figure 2.
Diagnoses presented by quarter between 2014 and 2022 in children admitted to PACU at Padua Hospital. MISC, multisystem inflammatory syndrome in children; SSTIs, skin and soft tissue infections; VOC, vasoocclusive crisis.
Figure 3.
Figure 3.
The analyses of prescription trends between 2014 and 2022 for all antibiotics by quarter and between 2015 and 2022 for URTI and LRTI by half-year (joinpoint analysis). DOT/1000PD, days of therapy/1000 patient days; Q1–4, quarters S1–4 semesters.
Figure 4.
Figure 4.
Class of antibiotics prescribed per quarter between 2014 and 2022 in children admitted to PACU at Padua Hospital.
See this image and copyright information in PMC

References

    1. Jackson C, Hsia Y, Bielicki JA et al. Estimating global trends in total and childhood antibiotic consumption, 2011–2015. BMJ Glob Health 2019; 4: e001241. 10.1136/bmjgh-2018-001241 - DOI - PMC - PubMed
    1. Browne AJ, Chipeta MG, Haines-Woodhouse G et al. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study. Lancet Planet Health 2021; 5: e893–904. 10.1016/S2542-5196(21)00280-1 - DOI - PMC - PubMed
    1. Gerber JS, Newland JG, Coffin SE et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010; 126: 1067–73. 10.1542/peds.2010-1275 - DOI - PMC - PubMed
    1. Zetts RM, Stoesz A, Smith BA et al. Outpatient antibiotic use and the need for increased antibiotic stewardship efforts. Pediatrics 2018; 141: e20174124. - PubMed
    1. Levy SB. Factors impacting on the problem of antibiotic resistance. J Antimicrob Chemother 2002; 49: 25–30. 10.1093/jac/49.1.25 - DOI - PubMed

LinkOut - more resources