重新审视儿科重症监护病房的抗菌药物管理：来自非常规方法的见解。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-03-01 DOI:10.1016/j.jhin.2025.02.010

C. Liberati , G. Brigadoi , E. Gres , E. Barbieri , F. Cavagnero , L. Maestri , S. Trivellato , A. Zenere , M. De Pieri , C. Di Chiara , D. Mengato , F. Venturini , E. De Canale , C. Del Vecchio , A. Tessari , A. Tosoni , C. Zaggia , C. Contessa , C. Giaquinto , E. Carrara , D. Donà

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引用次数: 0

摘要

背景：儿科重症监护病房（PICU）的患者是高危人群，接受不适当抗菌药物处方的可能性较高。本研究描述了意大利一家三级医院PICU的抗菌药物管理计划（ASP）。方法：于2019年1月1日至2022年12月31日在帕多瓦大学医院妇幼卫生科PICU进行前后准实验研究。ASP干预始于2021年2月，由一个多学科团队使用“握手”方法。人群包括所有入PICU的患者。主要终点是抗生素用量，以治疗天数(DOTs)/1000患者日计算。使用中断时间序列分析来评估干预前后抗生素处方的趋势。结果：干预前阶段（2019年1月- 2021年1月）入院616例（发作），干预后阶段（2021年2月- 2022年12月）入院602例（发作）。对于总体抗生素消耗，ASP的实施导致每月显著减少3.0% （p< 0.0001）。高消费抗生素的月减量为：美罗培南4.9% (p=0.009)，糖肽3.8% (p=0.014)，哌拉西林-他唑巴坦4.8% （p=0.034）。第三代头孢菌素和阿米卡星的用量无显著差异。结论：ASP干预在这种复杂的环境中有效地减少了抗菌素的消耗。这些结果表明，在重症儿童的情况下，抗菌药物管理的重要性。

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Revisiting antimicrobial stewardship in the paediatric intensive care unit: insights from an unconventional approach

Background

Patients admitted to the paediatric intensive care unit (PICU) constitute a high-risk group with increased likelihood of receiving inappropriate antimicrobial prescriptions. This study describes an antimicrobial stewardship programme (ASP) in the PICU of a tertiary hospital in Italy.

Method

A pre–post quasi-experimental study was conducted between 1^st January 2019 and 31^st December 2022 in the PICU of the Department for Women's and Children's Health, University Hospital of Padova. The ASP intervention was implemented in February 2021 by a multi-disciplinary team using the ‘handshake’ approach. The population included all patients admitted to the PICU. The primary outcome was antibiotic consumption measured as days of therapy administered (DOTs)/1000 patient-days. An interrupted time series analysis was used to assess trends in antibiotic prescribing before and after the intervention.

Results

In total, 616 patients (episodes) were admitted in the pre-intervention phase (January 2019–January 2021) and 602 patients were admitted in the post-intervention phase (February 2021–December 2022). Implementation of the ASP resulted in a significant decrease in overall antibiotic consumption by 3.0% every month (P<0.0001). Monthly reductions in higher consumption antibiotics were: meropenem, 4.9% (P=0.009); glycopeptides, 3.8% (P=0.014); and piperacillin-tazobactam 4.8% (P=0.034). The consumption of third-generation cephalosporins and amikacin did not change significantly.

Conclusions

The ASP intervention was effective in reducing the consumption of antimicrobials in this complex setting. These results show the importance of antimicrobial stewardship in the scenario of critically ill children.

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.