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
{"title":"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。","authors":"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","doi":"10.1016/j.jhin.2025.02.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Method</h3><div>A pre–post quasi-experimental study was conducted between 1<sup>st</sup> January 2019 and 31<sup>st</sup> 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.</div></div><div><h3>Results</h3><div>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 (<em>P</em><0.0001). Monthly reductions in higher consumption antibiotics were: meropenem, 4.9% (<em>P</em>=0.009); glycopeptides, 3.8% (<em>P</em>=0.014); and piperacillin-tazobactam 4.8% (<em>P</em>=0.034). The consumption of third-generation cephalosporins and amikacin did not change significantly.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"160 ","pages":"Pages 53-59"},"PeriodicalIF":3.9000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Revisiting antimicrobial stewardship in the paediatric intensive care unit: insights from an unconventional approach\",\"authors\":\"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\",\"doi\":\"10.1016/j.jhin.2025.02.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Method</h3><div>A pre–post quasi-experimental study was conducted between 1<sup>st</sup> January 2019 and 31<sup>st</sup> 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.</div></div><div><h3>Results</h3><div>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 (<em>P</em><0.0001). Monthly reductions in higher consumption antibiotics were: meropenem, 4.9% (<em>P</em>=0.009); glycopeptides, 3.8% (<em>P</em>=0.014); and piperacillin-tazobactam 4.8% (<em>P</em>=0.034). The consumption of third-generation cephalosporins and amikacin did not change significantly.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":54806,\"journal\":{\"name\":\"Journal of Hospital Infection\",\"volume\":\"160 \",\"pages\":\"Pages 53-59\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hospital Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0195670125000519\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hospital Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0195670125000519","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
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 1st January 2019 and 31st 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.
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.