The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children
The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children
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DOI：
10.1093/jac/dkv418
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发表时间：
2016-04-01
影响因子：
5.2
通讯作者：
Goossens, Herman
中科院分区：
文献类型：
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作者：
Versporten, Ann;Bielicki, Julia;Goossens, Herman
以前，基于网络的工具，横截面抗菌点患病率调查（PPS）已被用于成人制定质量改进的指标。我们的目的是确定开发类似的改进抗菌药物处方质量指标的可行性，特别关注全球住院新生儿和儿童。采用标准化抗菌药物PPS方法。纳入PPS当天上午8：00接受抗菌药物治疗的所有住院儿童和新生儿。分母包括住院患者总数。使用了一个基于网络的应用程序进行数据输入、验证和报告。我们分析了来自欧洲41个国家（C）226家医院（H）的2012年数据（174 H; 24 C）、非洲（6 H; 4 C）、亚洲（25 H; 8 C）、澳大利亚（6 H; 3C）和北美（4 H）。在17 aEuros 693招生，6499（36.7%）的住院患者接受了至少一种抗菌药物，但这在病房和地区之间差异很大。潜在指标包括儿童中非常高的广谱抗生素处方，主要是头孢曲松（东欧排名第一，31.3%;亚洲，13.0%;南欧，9.8%），头孢吡肟（北美排名第三，7.8%）和美罗培南（拉丁美洲排名第一，13.1%）。该调查发现，与儿童（28.3%;从非洲的14.5%到拉丁美洲的48.9%）相比，新生儿（34.9%;从非洲的14.2%到拉丁美洲的68.0%）医院获得性感染的关键重要抗生素使用率高得令人担忧。胃肠外给药在亚洲（88%）、拉丁美洲（81%）和欧洲（67%）的儿童中非常常见。拉丁美洲对抗生素处方原因的记录最低（52%）。延长手术预防率范围从78%（欧洲）到84%（拉丁美洲）。简单的基于网络的PPS工具提供了一种可行的方法，以确定改善抗生素使用的领域，设定基准，并监测住院新生儿和儿童的未来干预措施。据我们所知，这项研究得出了第一个住院新生儿和儿童抗生素使用的全球质量指标。
Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide.A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H).Of 17aEuroS693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America).Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children.