Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Germany.
Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium.
J Pediatric Infect Dis Soc. 2019 May 11;8(2):143-151. doi: 10.1093/jpids/piy019.
This study was conducted to assess the variation in prescription practices for systemic antimicrobial agents used for prophylaxis among pediatric patients hospitalized in 41 countries worldwide.
Using the standardized Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey protocol, a cross-sectional point-prevalence survey was conducted at 226 pediatric hospitals in 41 countries from October 1 to November 30, 2012.
Overall, 17693 pediatric patients were surveyed and 36.7% of them received antibiotics (n = 6499). Of 6818 inpatient children, 2242 (32.9%) received at least 1 antimicrobial for prophylactic use. Of 11899 prescriptions for antimicrobials, 3400 (28.6%) were provided for prophylactic use. Prophylaxis for medical diseases was the indication in 73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for surgical diseases (905 of 3400). In approximately half the cases (48.7% [1656 of 3400]), a combination of 2 or more antimicrobials was prescribed. The use of broad-spectrum antibiotics (BSAs), which included tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim, was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for medical prophylaxis was more common in Asia (risk ratio [RR], 1.322; 95% confidence interval [CI], 1.202-1.653) and more restricted in Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for surgical prophylaxis also varied according to United Nations region. Finally, a high percentage of surgical patients (79.7% [721 of 905]) received their prophylaxis for longer than 1 day.
A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.
本研究旨在评估全球 41 个国家 226 家儿科医院住院患儿中，全身用抗菌药物预防用药的处方实践差异。
采用标准化的《欧洲儿童抗菌药物耐药和处方管理点 prevalence 调查方案》，于 2012 年 10 月 1 日至 11 月 30 日在 41 个国家的 226 家儿科医院开展横断面时点 prevalence 调查。
共调查 17693 例患儿，其中 36.7%（6499 例）接受了抗菌药物治疗。6818 例住院患儿中，2242 例（32.9%）至少接受了 1 种抗菌药物用于预防用药。11899 例抗菌药物处方中，3400 例（28.6%）用于预防用药。73.4%（2495 例）的预防用药适用于医学疾病，26.6%（905 例）适用于手术疾病。大约一半（48.7%[1656 例]）的病例处方联合使用了 2 种或以上抗菌药物。广谱抗菌药物（包括四环素类、大环内酯类、林可酰胺类和磺胺类/甲氧苄啶类）的使用率较高（51.8%[1761 例]）。亚洲地区医学预防用药中广谱抗菌药物的使用更为常见（风险比[RR]，1.322；95%置信区间[CI]，1.202-1.653），而澳大利亚地区则受到更严格的限制（RR，0.619；95%CI，0.521-0.736）。根据联合国区域，手术预防用药中使用广谱抗菌药物也存在差异。最后，大多数手术患儿（79.7%[721 例]）的预防用药时间超过 1 天。
很大比例的住院患儿接受了预防性广谱抗菌药物治疗。这是一个明确的质量改进目标。总的来说，需要减少总体预防性处方、广谱抗菌药物的使用和延长处方时间。
