Haase R, Baier J, Cristofolini M, Scheller K, Moritz S
Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Halle, Halle.
Klinik für Neonatologie und Kinderintensivmedizin, Krankenhaus St. Elisabeth und St. Barbara, Halle.
Pneumologie. 2021 Jul;75(7):507-515. doi: 10.1055/a-1346-4444. Epub 2021 Feb 8.
Pediatric community-acquired pneumonia (pCAP) often leads to prescription of antibiotics and hospital admission of children. Unfortunately, adherence to diagnosis and treatment guidelines is inconsistent, and misuse of antibiotics may occur. Antimicrobial stewardship interventions, which were started in many hospitals during the last decade, can optimize management of pCAP without negative patient outcomes.
The objective of this retrospective analysis was to assess the influence of a newly implemented in-house pediatric antibiotic stewardship (ABS) initiative on guideline adherence and treatment quality.
Retrospective, patients' file-based analysis of the effects of an ABS initiative in a pediatric university hospital from January 2017 until March 2020. ABS initiative included creation of a local pCAP guideline for hospitalized children aged 90 days - 18 years, periodic training and continuous ABS support.
A total of 230 patients with pCAP were included (145 before and 85 after intervention). Implementation of the ABS program led to reduction of antibiotics prescription without clear indication from 26 % to 10 % (p < 0.05). The inappropriate use of antibiotics decreased from 64 % to 27 % (p < 0.05), the rate of incorrect doses declined from 17 % to 10 % (p < 0.05) and the mean duration of antibiotic treatment declined from 10 to 7 days (p < 0.05). There were no differences between the two groups regarding length of stay, treatment failure or readmissions for respiratory infection.
Pediatric antibiotic stewardship is an appropriate and safe method, and is beneficial to hospitalized patients with pCAP. Application of ABS programs may increase adherence to clinical guidelines and improve appropriate antimicrobial use without negative impact on patient outcomes. Multicenter follow-up studies are needed to clarify long-term effects of ABS programs.
儿童社区获得性肺炎（pCAP）常常导致儿童使用抗生素并住院治疗。遗憾的是，对诊断和治疗指南的遵循情况并不一致，可能会出现抗生素滥用的情况。抗菌药物管理干预措施在过去十年中已在许多医院开展，其可优化pCAP的管理且不会给患者带来不良后果。
本回顾性分析的目的是评估新实施的院内儿童抗生素管理（ABS）举措对指南遵循情况和治疗质量的影响。
对一所儿科大学医院在2017年1月至2020年3月期间开展的ABS举措的效果进行回顾性、基于患者病历的分析。ABS举措包括为90天至18岁的住院儿童制定当地pCAP指南、定期培训以及持续的ABS支持。
共纳入230例pCAP患者（干预前145例，干预后85例）。ABS项目的实施使无明确指征的抗生素处方从26%降至10%（p<0.05）。抗生素的不当使用从64%降至27%（p<0.05），剂量错误率从17%降至10%（p<0.05），抗生素治疗的平均时长从10天降至7天（p<0.05）。两组在住院时长、治疗失败或呼吸道感染再入院方面无差异。
儿童抗生素管理是一种合适且安全的方法，对住院的pCAP患者有益。应用ABS项目可能会提高对临床指南的遵循度，并改善抗菌药物的合理使用，且不会对患者预后产生负面影响。需要开展多中心随访研究以阐明ABS项目的长期效果。
