Natalia Mendoza-Palomar (Spain)
Vall d'Hebron Universitary Hospital Paediatric Infectious Diseases and Immunodeficiencies UnitPresenter of 1 Presentation
ANTIBIOTIC CONSUMPTION IN THE PAEDIATRIC INTENSIVE CARE UNIT: THE IMPACT OF 5 YEARS OF PAEDIATRIC ANTIBIOTIC STEWARDSHIP PROGRAM (ID 1003)
Abstract
Background
Paediatric intensive care units (PICU) are challenging settings for paediatric Antibiotic Stewardship Programs (p-ASP), in relation with critically ill patients, multidrug-resistant (MDR) microorganisms and healthcare-acquired infections. Since 2015, our non-restrictive p-ASPperforms biweekly audits, guidelines development and MDR monitoring in our hospital’s PICU. Our aim was to describe the evolution of antibiotic consumption in PICU from the pASP outset.
Methods
Antibiotic prescription data was collected retrospectively from the electronic prescription program (Centricity Care®), January 2015 to December 2019. Antibiotic consumption was defined as Days of therapy (DOT) per 100 occupied bed-days (OBD). Proportion of broad-spectrum antibiotics (glycopeptides, 3rd-and4th-generation cephalosporins, monobactams, carbapenems, fluoroquinolones, polymyxins, piperacillin-tazobactam, oxazolindiones, daptomycin) was also assessed. Statistical significance of antibiotic consumption trends was evaluated using linear regression.
Results
Overall consumption of antibacterials significantly decreased from 132.19 to 64.11 DOT/100 OBD from 2015 to 2019. The most frequently used antibacterial were combinations of penicillins incl. beta-lactamase inhibitors (29%), glycopeptides (15.3%) and carbapenems (12.8%). A statistically significant decrease was observed for overall broad-spectrum antibacterials, combinations of penicillins incl. beta-lactamase inhibitors, glycopeptides and fluoroquinolones. Carbapenems, aminoglycosides and 3rd-generation cephalosporins showed a non- significant decrease(figure1). Due to a greater decrease of overall use of antibacterials than in those with broader spectrum, a non-significant increase in the proportion of the latter was observed.
Conclusions
After pASP implementation, significant changes in antibiotic consumption occurred in PICU. Changes were consistent with pASP actions, that aimed to reduce the length and the spectrum of empiric antibiotics. An extra effort is needed to consolidate the decrease in carbapenems and aminoglycosides due to their usefulness in the treatment of MDR microorganisms in critically ill patients.