Challenges of Antibiotic Stewardship in the Pediatric and Neonatal Intensive Care Units.
Challenges of Antibiotic Stewardship in the Pediatric and Neonatal Intensive Care Units.
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DOI：
10.5863/1551-6776-26.7.659
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发表时间：
2021-01-01
期刊：
影响因子：
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通讯作者：
Stultz, Jeremy S
中科院分区：
文献类型：
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作者：
Branstetter, Joshua W;Barker, Leanna;Stultz, Jeremy S
抗菌药物管理计划（ASP）的目标是优化抗菌药物处方习惯，以改善患者结局，减少抗菌药物耐药性，并降低医院成本。多个社会认可的指导方针和政府政策加强了ASP实施的重要性。有效的抗菌药物管理可以影响独特的患者，医院和社会耐药性负担。这些方案的作用和随后的成功在很大程度上是在成年人口中报告的。儿科和新生儿重症监护室对传统的抗菌药物管理方法提出了独特的挑战。这篇综述文章的目的是探讨在儿科和新生儿重症监护病房中适当使用抗生素的挑战，并总结ASP可以用来克服这些挑战的策略。这些问题包括非特异性疾病表现，在许多儿科感染中确定治疗持续时间的证据有限，儿科培训的传染病医生较少，以及密集的实验室获取，收集和解释的适用性。此外，许多评估ASP疗效的ASP实施研究排除了PICU和NICU。儿科ASP的重点领域可能包括适当的抗生素启动，适当的抗生素持续时间和适当的抗生素降级。
The goals of antimicrobial stewardship programs (ASPs) are to optimize antimicrobial prescribing habits in order to improve patient outcomes, reduce antimicrobial resistance, and reduce hospital costs. Multiple society-endorsed guidelines and government policies reinforce the importance of ASP implementation. Effective antimicrobial stewardship can impact unique patients, hospitals, and societal antibiotic-resistance burden. The role and subsequent success of these programs has largely been reported in the adult population. Pediatric and neonatal intensive care units present unique challenges for traditional antimicrobial stewardship approaches. The purpose of this review article is to explore the challenges of appropriate antibiotic use in the pediatric and neonatal intensive care units and to summarize strategies ASPs can use to overcome these challenges. These problems include non-specific disease presentations, limited evidence for definitive treatment durations in many pediatric infections, fewer pediatric-trained infectious disease physicians, and applicability of intensive laboratory obtainment, collection, and interpretation. Additionally, many ASP implementation studies evaluating the efficacy of ASPs exclude the PICU and NICU. Areas of focus for pediatric ASPs should likely include appropriate antibiotic initiation, appropriate antibiotic duration, and appropriate antibiotic de-escalation.