Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK
Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK
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DOI：
10.1136/bmjopen-2016-012675
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Sharland, Mike
中科院分区：
文献类型：
--
作者：
Gharbi, Myriam;Doerholt, Katja;Sharland, Mike
背景资料：英格兰国家卫生服务局抗菌素耐药性质量和创新委员会（CQUIN AMR）旨在减少抗生素的总消费量和某些广谱抗生素在二级保健中的使用。然而，住院儿童缺乏可靠的基线抗生素使用数据。在这项研究中，我们的目的是描述，比较和解释抗生素的处方模式，在英国的儿科单位和之间，并提供一个基线抗生素处方为未来的改善使用CQUIN AMR guidance.Methods：我们进行了一项横断面研究，使用点患病率调查（PPS）在61个儿科单位在英国各地。使用欧洲儿童抗生素耐药性和处方（ARPEC）项目的标准化研究方案。所有18岁以下的住院患者目前在参与医院的研究当天，除新生儿included.Results：共1247（40.9%）的3047名儿童住院的PPS的一天抗生素。儿童接受抗生素治疗的比例在地区综合医院和三级医院之间差异很大，分别为36.4%（95%CI 33.4%至39.4%）和43.0%（95%CI 40.9%至45.1%）的儿童使用抗生素。约四分之一接受抗生素治疗的儿童接受药物或手术预防，胃肠外给药是抗生素的主要处方途径（两种类型医院的处方>60%）。普通儿科单位是令人惊讶的高处方的关键广谱抗生素，即，碳青霉烯类和哌拉西林-他唑巴坦。结论：我们提供了一个强大的基线抗生素处方在住院儿童在目前的国家管理工作在英国。重复PPS与耐药性数据的进一步联系需要成为抗生素管理策略的一部分，以解决住院儿童中抗生素使用不佳的问题。
Background: The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.Methods: We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.Results: A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% (95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.Conclusions: We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.