Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Eur J Clin Microbiol Infect Dis. 2017 Aug;36(8):1449-1454. doi: 10.1007/s10096-017-2952-5. Epub 2017 Mar 10.
Antimicrobial stewardship programs (ASPs) have been introduced in most hospital complexes; however, they are not always useful for pediatric patients. The aim of this study is to investigate the efficacy of direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in a tertiary medical facility without pediatric ASP. This retrospective study included 1,821 patients who were hospitalized in the pediatric ward of a large metropolitan hospital from 2010 to 2015. The clinical course, the use of intravenous antimicrobial agents and the results of a microbiological analysis were compared between the period after the beginning of direct intervention by the specialist (post-intervention period) and the previous period (pre-intervention period). In the post-intervention period, the proportion of the patients who received intravenous antimicrobial agents, the number of antimicrobial agents used for each episode, and the proportion of episodes in which an antimicrobial agent was re-administrated were significantly lower (P = 0.006, P = 0.004, P = 0.036, respectively), and the duration of antimicrobial treatment was significantly shorter (P < 0.001). In addition, narrower spectrum antimicrobial agents were used, and the incidence of meropenem-sensitive Pseudomonas aeruginosa significantly increased (P = 0.037) in the post-intervention period. There was no change of mortality between the two periods. Direct clinical intervention by a pediatric infectious diseases specialist is useful for the treatment of infectious diseases in the pediatric ward of a tertiary medical facility without a pediatric ASP. The creation of a pediatric ASP is recommended in hospital complexes.
抗菌药物管理计划（ASPs）已在大多数医院中引入；然而，它们并不总是对儿科患者有用。本研究旨在调查在没有儿科 ASP 的三级医疗机构中，由儿科传染病专家直接对传染病进行临床干预的效果。这项回顾性研究包括了 2010 年至 2015 年期间在一家大型都市医院儿科病房住院的 1821 名患者。比较了专家直接干预开始后的时期（干预后时期）和之前的时期（干预前时期）的临床病程、静脉用抗菌药物的使用情况和微生物学分析结果。在干预后时期，接受静脉用抗菌药物的患者比例、每个发作使用的抗菌药物数量以及重新使用抗菌药物的发作比例均显著降低（P = 0.006、P = 0.004、P = 0.036，分别），抗菌治疗的持续时间显著缩短（P < 0.001）。此外，在干预后时期，使用了更窄谱的抗菌药物，并且对美罗培南敏感的铜绿假单胞菌的发生率显著增加（P = 0.037）。两个时期之间的死亡率没有变化。在没有儿科 ASP 的三级医疗机构的儿科病房中，由儿科传染病专家进行直接临床干预对治疗传染病是有用的。建议在医院建筑群中创建儿科 ASP。
