Aljassim Nada A, Noël Kim C, Maratta Christina, Tam Ingrid, Almadani Ahmed, Papenburg Jesse, Quach Caroline, Thampi Nisha, McNally James D, Dendukuri Nandini, Lefebvre Marie-Astrid, Zavalkoff Samara, O'Donnell Shauna, Jouvet Philippe, Fontela Patricia S
Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Pediatr Crit Care Med. 2022 Mar 1;23(3):160-170. doi: 10.1097/PCC.0000000000002834.
To determine the association between the implementation of an antimicrobial stewardship program at a local PICU and to determine the association between the presence of an antimicrobial stewardship programs and antimicrobial use across three Canadian PICUs, among critically ill children with bronchiolitis.
A multicenter retrospective cohort study.
Three Canadian PICUs over two winter seasons.
An antimicrobial stewardship program was implemented at PICU 1 at the end of season 1.
Patients less than or equal to 2 years old admitted with bronchiolitis.
We used regression models with an interaction term between site (PICU 1 and PICU 2) and season (1 and 2) as the primary analysis to determine the association between implementation of an antimicrobial stewardship program at PICU 1 and 1) the proportion of antimicrobials discontinued 72 hours after hospital admission (logistic regression), 2) antimicrobial treatment duration (negative binomial regression), and 3) antimicrobial prescriptions within 48 hours of hospital admission (logistic regression). As a secondary analysis, we determined the association between having an antimicrobial stewardship program present and the aforementioned outcomes across the three PICUs. A total of 372 patients were included. During seasons 1 and 2, median age was 2.2 months (interquartile range, 1.2-6.2 mo) and 2.1 months (interquartile range, 1.3-6.8 mo), respectively. Among patients with viral bronchiolitis, implementation of an antimicrobial stewardship program at PICU 1 was associated with increased odds of discontinuing antimicrobials (odds ratio, 25.63; 95% CI, 2.86-326.29), but not with antimicrobial duration (odds ratio, 0.56; 95% CI, 0.31-1.02) or antimicrobial prescriptions (odds ratio, 0.33; 95% CI, 0.10-1.04). The presence of an antimicrobial stewardship program was similarly associated with antimicrobial discontinuation among patients with viral bronchiolitis (odds ratio, 20.79; 95% CI, 2.46-244.92), but not with antimicrobial duration (odds ratio, 0.57; 95% CI, 0.32-1.03) or antimicrobial prescriptions (odds ratio, 0.37; 95% CI, 0.12-1.11).
Antimicrobial stewardship programs were associated with increased likelihood of discontinuing antimicrobial treatments in the PICU patients with viral bronchiolitis. However, larger studies are needed to further determine the role of an antimicrobial stewardship programs in reducing unnecessary antimicrobial use in this patient population.
确定在当地一家儿科重症监护病房（PICU）实施抗菌药物管理计划之间的关联，并确定在三家加拿大PICU中，对于患有细支气管炎的重症儿童，抗菌药物管理计划的存在与抗菌药物使用之间的关联。
一项多中心回顾性队列研究。
两个冬季期间的三家加拿大PICU。
在第1季末，在PICU 1实施了抗菌药物管理计划。
因细支气管炎入院的2岁及以下患者。
我们使用带有地点（PICU 1和PICU 2）与季节（第1季和第2季）之间交互项的回归模型作为主要分析方法，以确定在PICU 1实施抗菌药物管理计划与以下方面的关联：1）入院72小时后停用抗菌药物的比例（逻辑回归）；2）抗菌治疗持续时间（负二项回归）；3）入院48小时内的抗菌药物处方（逻辑回归）。作为次要分析，我们确定了存在抗菌药物管理计划与三家PICU中上述结果之间的关联。共纳入372例患者。在第1季和第2季期间，中位年龄分别为2.2个月（四分位间距，1.2 - 6.2个月）和2.1个月（四分位间距，1.3 - 6.8个月）。在病毒性细支气管炎患者中，PICU 1实施抗菌药物管理计划与停用抗菌药物的几率增加相关（比值比，25.63；95%置信区间，2.86 - 326.29），但与抗菌药物持续时间（比值比，0.56；95%置信区间，0.31 - 1.02）或抗菌药物处方（比值比，0.33；95%置信区间，0.10 - 1.04）无关。抗菌药物管理计划的存在与病毒性细支气管炎患者停用抗菌药物同样相关（比值比，20.79；95%置信区间，2.46 - 244.92），但与抗菌药物持续时间（比值比，0.57；95%置信区间，0.32 - 1.03）或抗菌药物处方（比值比，0.37；95%置信区间，0.12 - 1.11）无关。
抗菌药物管理计划与PICU中患有病毒性细支气管炎患者停用抗菌治疗的可能性增加相关。然而，需要更大规模的研究来进一步确定抗菌药物管理计划在减少该患者群体不必要抗菌药物使用方面的作用。
