Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker-Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015, Paris, France.
Department of Gut Inflammation, Center for Research on Inflammation CRI, INSERM 1149, Université de Paris, 75006, Paris, France.
Eur J Clin Microbiol Infect Dis. 2021 May;40(5):1039-1048. doi: 10.1007/s10096-020-04103-3. Epub 2021 Jan 3.
Antimicrobial stewardship programs aim at reducing the overuse of broad-spectrum antibiotics such as carbapenems, but their impact remains unclear. We compared the use of carbapenems between paediatric and adult subjects admitted to a French tertiary hospital and described the intervention of an antibiotic stewardship team (AST). As part of AST routine activity, all adult and paediatric patients receiving carbapenems are identified in real time using a computer-generated alert system and reviewed by the AST. Data associated with carbapenem prescriptions were extracted for 2 years (2014-2015) and were compared between paediatric and adult wards. Prescription appropriateness (i.e. no clinically suitable narrower spectrum alternative to carbapenem for de-escalation) and AST intervention were analysed. In total, 775 carbapenem prescriptions for 291 children and 262 adults were included. Most patients (95%) had a comordity and 52% had known recent carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE). Most carbapenem prescriptions came from intensive care units (n = 269, 35%) and were initiated for urinary tract (n = 200, 27%), sepsis (n = 181, 25%), and lung (n = 153, 21%) infections. Carbapenems were initiated empirically in 537 (70%) cases, and an organism was isolated in 523 (67%) cases. Among the isolated organisms, 47% (n = 246) were ESBLE and 90% (n = 468) were susceptible to carbapenems, but an alternative existed in 61% (n = 320) of cases according to antibiotic susceptibility testing. Among prescriptions reviewed by the AST, 39% (n = 255) were considered non-appropriate and led to either antibiotic discontinuation (n = 47, 7%) or de-escalation (n = 208, 32%). Non-appropriate prescriptions were more frequent in paediatric wards (p = 0.01) and in microbiologically documented infections (p = 0.013), and less observed in immunocompromised patients (p = 0.009) or with a known ESBLE carriage (p < 0.001). Tailored stewardship programs are essential to better control carbapenem use and subsequent antimicrobial resistance.
抗菌药物管理计划旨在减少广谱抗生素（如碳青霉烯类）的过度使用，但它们的影响仍不清楚。我们比较了法国一家三级医院收治的儿科和成人患者中碳青霉烯类药物的使用情况，并描述了抗菌药物管理团队（AST）的干预情况。作为 AST 常规活动的一部分，使用计算机生成的警报系统实时识别所有接受碳青霉烯类药物治疗的成人和儿科患者，并由 AST 进行审查。提取了 2 年（2014-2015 年）与碳青霉烯类药物处方相关的数据，并比较了儿科和成人病房的数据。分析了处方的适宜性（即没有临床适宜的窄谱替代碳青霉烯类药物用于降阶梯治疗）和 AST 干预情况。共纳入 291 例儿童和 262 例成人的 775 例碳青霉烯类药物处方。大多数患者（95%）有合并症，52%有近期携带产超广谱β-内酰胺酶肠杆菌科（ESBLE）的病史。大多数碳青霉烯类药物处方来自重症监护病房（n=269，35%），起始用于尿路感染（n=200，27%）、败血症（n=181，25%）和肺部感染（n=153，21%）。537 例（70%）病例为经验性起始碳青霉烯类药物治疗，523 例（67%）病例分离出病原体。在分离出的病原体中，47%（n=246）为 ESBLE，90%（n=468）对碳青霉烯类药物敏感，但根据抗生素药敏试验，61%（n=320）的病例存在替代药物。AST 审查的处方中，39%（n=255）被认为不适当，导致抗生素停药（n=47，7%）或降阶梯治疗（n=208，32%）。儿科病房（p=0.01）和微生物学确诊感染（p=0.013）中不适当处方更为常见，免疫功能低下患者（p=0.009）或有 ESBLE 携带史患者（p<0.001）中不适当处方较少。制定针对性的管理计划对于更好地控制碳青霉烯类药物的使用和随后的抗菌药物耐药性至关重要。
