Brett Ana, Bielicki Julia, Newland Jason G, Rodrigues Fernanda, Schaad Urs B, Sharland Mike
From the *Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro, Hospitalar e Universitário de Coimbra, Coimbra, Portugal; †Paediatric Infectious Diseases Research Group, St George's University London, London, United Kingdom; ‡Division of Pediatric Infectious Diseases, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City, MO; and §Paediatric Infectious Diseases Division, University Children's Hospital, Basel, Switzerland.
Pediatr Infect Dis J. 2013 Dec;32(12):e456-65. doi: 10.1097/INF.0b013e31829f0460.
The relationship between suboptimal use of antimicrobials and antimicrobial resistance has become increasingly clear. Despite significant international effort aimed at reducing inappropriate antimicrobial prescribing in hospitals, antimicrobial resistance remains a major public health threat. Antimicrobial Stewardship Programs (ASPs) comprise a series of measures aimed at optimizing the use of antimicrobials, while improving the quality of patient care and promoting cost-effectiveness. This discussion article aims to summarize some of the approaches that have been used in neonatal and pediatric ASPs, with a particular focus on the European healthcare setting. Current evidence demonstrates neonatal and pediatric ASPs to be safe, practical to implement, generally cost-effective and possibly associated with a reduction in antimicrobial resistance rates. This review identified that, despite the recognized need for additional evidence and information on implementation, published data on pediatric ASPs derives mainly from the United States, with very few published reports on formal ASPs in European children's hospitals. Consequently, the optimal method of implementation remains unknown within a European setting. Future research needs to include novel study designs on how best to introduce ASPs, monitoring of clinically relevant outcomes and cost-effectiveness with improved measurement of the impact on antimicrobial resistance.
抗菌药物使用不当与抗菌药物耐药性之间的关系日益明晰。尽管国际社会为减少医院内抗菌药物的不适当处方做出了重大努力，但抗菌药物耐药性仍然是主要的公共卫生威胁。抗菌药物管理计划（ASPs）包括一系列旨在优化抗菌药物使用的措施，同时提高患者护理质量并促进成本效益。这篇讨论文章旨在总结新生儿和儿科抗菌药物管理计划中使用的一些方法，特别关注欧洲的医疗环境。目前的证据表明，新生儿和儿科抗菌药物管理计划是安全的，实施起来切实可行，总体上具有成本效益，并且可能与抗菌药物耐药率的降低有关。这篇综述发现，尽管人们认识到需要更多关于实施的证据和信息，但已发表的儿科抗菌药物管理计划的数据主要来自美国，欧洲儿童医院关于正式抗菌药物管理计划的已发表报告很少。因此，在欧洲环境中，最佳的实施方法仍然未知。未来的研究需要包括关于如何最好地引入抗菌药物管理计划的新颖研究设计、对临床相关结果的监测以及成本效益，并改进对抗菌药物耐药性影响的衡量。
