Spyridis N, Syridou G, Goossens H, Versporten A, Kopsidas J, Kourlaba G, Bielicki J, Drapier N, Zaoutis T, Tsolia M, Sharland M
Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece.
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
Arch Dis Child. 2016 Jan;101(1):72-6. doi: 10.1136/archdischild-2015-308255. Epub 2015 Sep 28.
To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics.
Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children.
84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy.
Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.
评估欧洲儿科医院常见感染指南的可用性及来源，并确定其内容和特点。
参与调查的医院完成了一份在线问卷，内容涉及抗生素处方指南的可用性和特点，以及针对5种常见感染综合征（呼吸道、泌尿道、皮肤和软组织、骨与关节感染以及新生儿和儿童败血症）的经验性抗生素治疗，包括治疗疗程。
来自19个欧洲国家的84家医院参与了此次调查，其中74家确认存在指南。20%的医院报告有完整的指南（涵盖所有要求的感染综合征的现有指南），大多数医院（71%）使用了多种不同来源。最常见的指南是关于尿路感染（UTI）（74%）、新生儿败血症（71%）和儿童败血症（65%）的指南。青霉素和阿莫西林是呼吸道感染（RTI）最常推荐的抗生素（高达76%），头孢菌素用于UTI（高达50%）以及皮肤和软组织感染（SSTI）和骨感染（分别为20%和30%）。抗葡萄球菌青霉素分别在43%和36%的SSTI和骨感染中被推荐使用。新生儿败血症的推荐包括20种不同的抗生素组合。治疗疗程指南大多适用于RTI和UTI（82%）。三分之一有败血症指南的医院提供了治疗疗程的建议。
欧洲儿科医院普遍缺乏全面的抗生素指南推荐。我们记录了大多数感染的多种抗生素及组合。需要大幅提高指南质量及其证据基础，将经验性治疗与耐药率联系起来。
