Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Pediatr Int. 2021 Dec;63(12):1458-1465. doi: 10.1111/ped.14703. Epub 2021 Nov 21.
Prospective audit and feedback is a method that allows the antimicrobial stewardship program (ASP) team to interact with attending physicians to tailor antibiotic therapy, including de-escalation, as appropriate. This study aimed to evaluate the acceptance and outcomes of ASP de-escalation recommendations in children who received meropenem.
A prospective cohort study was conducted in children aged 1 month to 18 years who received meropenem in a tertiary-care teaching hospital. The ASP team gave recommendation between 72 and 120 h after initiating meropenem therapy. Acceptance of de-escalation recommendations among primary physicians was evaluated within 24 h of recommendation. Outcomes included clinical success rate on the 7th day and incidence rate of acquisition of carbapenem-resistant gram-negative bacteria (CR-GNB) within 30 days.
From March to December 2019, 217 children with a median (interquartile range) age of 2.1 (0.6, 9.5) years received meropenem. The ASP team gave recommendations in 127 (58.5%) of cases for continuation of meropenem therapy and 90 (41.5%) of cases for de-escalation. The overall acceptance of ASP de-escalation recommendations was 57.8% (95%CI: 46.9-68.1%). Clinical success rates were 85.2% in the accepted group compared to 77.5% in the rejected group (P = 0.06). The incidence rate of acquisition of CR-GNB within 30 days after treatment was 5.8% in the accepted group and 15.8% in the rejected group (P = 0.03).
About half of the recommendations to de-escalate meropenem prescriptions were accepted through the ASP intervention. Carbapenem-resistant gram-negative bacteria acquisitions was less likely in the de-escalation group. A robust de-escalation strategy 72 h following carbapenem initiation should be encouraged to combat multidrug-resistant organisms.
前瞻性审核和反馈是一种允许抗菌药物管理计划（ASP）团队与主治医生互动以调整抗生素治疗方案的方法，包括适当的降级治疗。本研究旨在评估在接受美罗培南治疗的儿童中，ASP 降级建议的接受程度和结果。
这是一项在一家三级教学医院中接受美罗培南治疗的 1 个月至 18 岁儿童的前瞻性队列研究。ASP 团队在开始美罗培南治疗后 72 至 120 小时提出建议。在建议提出后 24 小时内评估初级医生对降级建议的接受程度。结果包括第 7 天的临床成功率和 30 天内获得耐碳青霉烯类革兰阴性菌（CR-GNB）的发生率。
2019 年 3 月至 12 月，217 名中位（四分位距）年龄为 2.1（0.6，9.5）岁的儿童接受了美罗培南治疗。ASP 团队在 127 例（58.5%）病例中建议继续使用美罗培南治疗，在 90 例（41.5%）病例中建议降级。ASP 降级建议的总体接受率为 57.8%（95%CI：46.9-68.1%）。在接受组中，临床成功率为 85.2%，而在拒绝组中为 77.5%（P=0.06）。在接受组中，治疗后 30 天内获得 CR-GNB 的发生率为 5.8%，而在拒绝组中为 15.8%（P=0.03）。
通过 ASP 干预，大约一半的美罗培南处方降级建议得到了接受。在降级组中，获得耐碳青霉烯类革兰阴性菌的可能性较低。应鼓励在开始使用碳青霉烯类药物后 72 小时实施强有力的降级策略，以对抗多药耐药菌。
