Department of Pediatrics, Mahidol University, Bangkok, Thailand.
Pediatr Int. 2022 Jan;64(1):e15227. doi: 10.1111/ped.15227.
Intensive care unit (ICU) settings typically have a high-volume prescription of carbapenems. Antimicrobial stewardship programs (ASPs) aim to promote appropriate antibiotic use. Handshake stewardship (HS) is adapted from ASPs but focuses on direct feedback to physicians who prescribed antibiotics regarding the appropriateness of antibiotic prescription. This study aimed to evaluate the impact and acceptability of HS on carbapenem consumption in pediatric critical care settings.
This study was conducted over 18 months spanning pre-and post-implementation of HS. Carbapenem prescriptions were automatically discontinued during the pre-implementation period after 72 h if no indications existed. During the post-implementation, HS was performed by direct feedback to ICU physicians regarding the appropriateness of carbapenem prescriptions within 24 h. The primary outcome was the carbapenem consumption rate, defined as days of therapy (DOT)/1,000 patient-ICU days. Secondary outcomes were the acceptability of HS, length of critical care stay (LOCS), 30-day infection-related mortality rate, and the rate of carbapenem-resistant Enterobacteriaceae (CRE).
There were 212 carbapenem prescriptions (163 patients) and 174 carbapenem prescriptions (110 patients) in the pre-and post-implementation periods, respectively. Carbapenem consumption decreased significantly from 667 to 369 DOT/1,000 patient-ICU days, with a median difference of 292 DOT/1,000 patient-ICU days (P < 0.001; 95% confidence interval: 175-408) after HS implementation. The acceptability of the HS was 95.4%. The LOCS, 30-day infection-related mortality, and CRE rate were not significantly different between pre-and post-implementation periods.
Handshake stewardship significantly reduced carbapenem prescription in critically ill pediatric patients without negatively affecting patient outcomes.
重症监护病房（ICU）通常有大量的碳青霉烯类抗生素处方。抗菌药物管理计划（ASPs）旨在促进抗生素的合理使用。握手式管理（HS）是从 ASP 演变而来的，但侧重于直接向开具抗生素的医生反馈抗生素处方的适当性。本研究旨在评估 HS 对儿科重症监护环境中碳青霉烯类药物消耗的影响和可接受性。
本研究在 HS 实施前后进行了 18 个月，碳青霉烯类抗生素处方在实施前，如果 72 小时内没有任何指征，将自动停止。在实施后，HS 通过在 24 小时内直接向 ICU 医生反馈碳青霉烯类抗生素处方的适当性来进行。主要结局是碳青霉烯类药物消耗率，定义为治疗天数（DOT）/1000 患者 ICU 天数。次要结局是 HS 的可接受性、重症监护住院时间（LOCS）、30 天感染相关死亡率和碳青霉烯类耐药肠杆菌科（CRE）的发生率。
实施前和实施后分别有 212 例（163 例患者）和 174 例（110 例患者）碳青霉烯类抗生素处方。实施 HS 后，碳青霉烯类药物消耗从 667 降至 369 DOT/1000 患者 ICU 天数，中位数差异为 292 DOT/1000 患者 ICU 天数（P < 0.001；95%置信区间：175-408）。HS 的可接受率为 95.4%。实施前后，LOC、30 天感染相关死亡率和 CRE 发生率无显著差异。
HS 显著减少了危重症儿科患者的碳青霉烯类药物处方，而不会对患者结局产生负面影响。
