Variation in paediatric hospital antibiotic guidelines in Europe
Variation in paediatric hospital antibiotic guidelines in Europe
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DOI：
10.1136/archdischild-2015-308255
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发表时间：
2016-01-01
影响因子：
5.2
通讯作者：
Sharland, M.
中科院分区：
文献类型：
--
作者：
Spyridis, N.;Syridou, G.;Sharland, M.
目的评估欧洲儿科医院常见感染指南的可用性和来源，并确定其内容和特点。设计参与医院完成了关于抗生素处方指南的可用性和特征以及经验性抗生素治疗（包括5种常见感染综合征的治疗持续时间）的在线问卷调查：呼吸道、泌尿道、皮肤和软组织，新生儿和儿童的骨关节和败血症。结果来自19个欧洲国家的84家医院参与了调查，其中74家确认存在的指导方针。20%的医院报告了完整的指南（所有要求的感染综合征的现有指南），大多数（71%）使用了一系列不同的来源。最常见的指南是尿路感染（UTI）（74%），新生儿败血症（71%）和儿童败血症（65%）。青霉素和阿莫西林是最常推荐用于呼吸道感染（RTI）的抗生素（高达76%），头孢菌素用于UTI（高达50%）以及皮肤和软组织感染（SSTI）和骨骼感染（分别为20%和30%）。分别有43%和36%的患者推荐使用抗葡萄球菌青霉素治疗SSTI和骨感染。新生儿败血症的建议包括20种不同的抗生素组合。治疗持续时间指南主要用于RTI和UTI（82%）。三分之一的医院与败血症的指南提供了建议的治疗长度。结论全面的抗生素指南的建议，一般缺乏从欧洲儿科医院。我们记录了大多数感染的多种抗生素和组合。需要大大提高指南的质量及其证据基础，将经验性治疗与耐药率联系起来。
Objective To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics. Design Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.Results 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.Conclusions Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.