Brigadoi Giulia, Rossin Sara, Visentin Davide, Barbieri Elisa, Giaquinto Carlo, Da Dalt Liviana, Donà Daniele
Paediatric Emergency Department, Department of Woman's and Children's Health, University of Padua, Padua, Italy.
Division of Paediatric Infectious Diseases, Department of Woman's and Children's Health, University of Padua, Padua, Italy.
Ther Adv Infect Dis. 2023 Jan 12;10:20499361221141771. doi: 10.1177/20499361221141771. eCollection 2023 Jan-Dec.
Antibiotics remain the most prescribed medicine in children worldwide, but half of the prescriptions are unnecessary or inappropriate, leading to an increase in antibiotic resistance. This study aims to systemically review the effects of different Antimicrobial Stewardship Programmes (ASPs) on reducing the rates of both antibiotic prescriptions and changes in antimicrobial resistance, and on the economic impact in paediatric emergency departments (PED) and primary care settings.
Embase, MEDLINE, and Cochrane Library were systematically searched, combining Medical Subject Heading and free-text terms for 'children' and 'antimicrobial' and 'stewardship'. The search strategy involved restrictions on dates (from 1 January 2007 to 30 December 2020) but not on language. Randomized controlled trials, controlled and non-controlled before and after studies, controlled and non-controlled interrupted time series, and cohort studies were included for review. The review protocol was registered at the PROSPERO International Prospective Register of Systematic Reviews: Registration Number CRD42021270630.
Of the 47,158 articles that remained after removing duplicates, 59 were eligible for inclusion. Most of the studies were published after 2015 (37/59, 62.7%) and in high-income countries (51/59, 86.4%). Almost half of the studies described the implementation of an ASP in the primary care setting (28/59, 47.5%), while 15 manuscripts described the implementation of ASPs in EDs (15/59, 25.4%). More than half of the studies (43/59, 72.9%) described the implementation of multiple interventions, whereas few studies considered the implementation of a single intervention. Antibiotic prescriptions and compliance with guidelines were the most frequent outcomes (47/59, 79.7% and 20/59, 33.9%, respectively). Most of the articles reported an improvement in these outcomes after implementing an ASP. Meanwhile, only very few studies focused on health care costs (6/59, 10.2%) and antimicrobial resistance (3/59 5.1%).
The implementation of ASPs has been proven to be feasible and valuable, even in challenging settings such as Emergency Departments and Primary care.
抗生素仍然是全球儿童中最常开具的药物，但一半的处方是不必要的或不恰当的，这导致抗生素耐药性增加。本研究旨在系统评价不同抗菌药物管理计划（ASP）对降低儿科急诊科（PED）和初级保健机构抗生素处方率和抗菌药物耐药性变化以及对经济影响的效果。
系统检索Embase、MEDLINE和Cochrane图书馆，结合医学主题词和“儿童”“抗菌药物”及“管理”的自由文本词。检索策略涉及对日期的限制（从2007年1月1日至2020年12月31日），但不限制语言。纳入随机对照试验、对照和非对照的前后研究、对照和非对照的中断时间序列以及队列研究进行综述。该综述方案已在PROSPERO国际前瞻性系统评价注册库注册：注册号CRD42021270630。
在去除重复文献后剩余的47158篇文章中，59篇符合纳入标准。大多数研究发表于2015年之后（37/59，62.7%）且来自高收入国家（51/59，86.4%）。几乎一半的研究描述了在初级保健机构实施ASP（28/59，47.5%），而15篇手稿描述了在急诊科实施ASP（15/59，25.4%）。超过一半的研究（43/59，72.9%）描述了多种干预措施的实施，而很少有研究考虑单一干预措施的实施。抗生素处方和指南依从性是最常见的结局（分别为47/59，79.7%和20/59，33.9%）。大多数文章报告实施ASP后这些结局有所改善。同时，只有极少数研究关注医疗保健成本（6/59，10.2%）和抗菌药物耐药性（3/59，5.1%）。
即使在急诊科和初级保健等具有挑战性的环境中，实施ASP已被证明是可行且有价值的。
