Kitt Eimear, Hayes Molly, Ballester Lance, Sewawa Kgotlaetsile B, Mulale Unami, Mazhani Loeto, Arscott-Mills Tonya, Coffin Susan E, Steenhoff Andrew P
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
SAGE Open Med. 2022 Jun 20;10:20503121221104437. doi: 10.1177/20503121221104437. eCollection 2022.
Over the past decade, concerning trends in antimicrobial resistance have emerged in Southern Africa. Given a paucity of pediatric data, our objectives were to (1) describe antibiotic utilization trends at a national referral center in Southern Africa and (2) assess the proportion of patients receiving antibiotics appropriately. In addition, risk factors for inappropriate use were explored.
We performed a prospective cohort study on medical and surgical pediatric patients aged below 13 years admitted to the country's tertiary care referral hospital in Gaborone, Botswana. We collected demographics, clinical, laboratory, and microbiology details, in addition to information on antibiotic use. We separately categorized antibiotic prescriptions using the World Health Organization AWaRe Classification of Access, Watch, and Restrict.
Our final cohort of 299 patients was 44% female and 27% HIV-exposed; most (68%) were admitted to the General Pediatrics ward. Infections were a common cause of hospitalization in 29% of the cohort. Almost half of our cohort were prescribed at least one antibiotic during their stay, including 40% on admission; almost half (47%) of these prescriptions were deemed appropriate. At the time of discharge, 52 (21%) patients were prescribed an antibiotic, of which 37% were appropriate. Of all antibiotics prescribed, 42% were from the World Health Organization Access antibiotic list, 58% were from the Watch antibiotic list, and 0% were prescribed antibiotics from the Restrict antibiotic list. Univariate analyses revealed that surgical patients were significantly more likely to have inappropriate antibiotics prescribed on admission. Patients who were treated for diseases for which there was a clinical pathway, or who had blood cultures sent at the time of admission were less likely to have inappropriate antibiotics prescribed. On multivariate analysis, apart from admission to the surgical unit, there were no independent predictors for inappropriate antibiotic use, although there was a trend for critically ill patients to receive inappropriate antibiotics.
Our study reveals high rates of antibiotic consumption, much of which was inappropriate. Promising areas for antimicrobial stewardship interventions include (1) standardization of management approaches in the pediatric surgical population and (2) the implementation of feasible and generalizable clinical pathways in this tertiary care facility.
在过去十年中，南部非洲出现了令人担忧的抗菌药物耐药性趋势。鉴于儿科数据匮乏，我们的目标是：（1）描述南部非洲一家国家级转诊中心的抗生素使用趋势；（2）评估接受抗生素治疗的患者中用药合理的比例。此外，还探讨了不合理用药的风险因素。
我们对博茨瓦纳哈博罗内该国三级医疗转诊医院收治的13岁以下儿科内科和外科患者进行了一项前瞻性队列研究。我们收集了人口统计学、临床、实验室和微生物学详细信息，以及抗生素使用信息。我们使用世界卫生组织的“获取、观察和限制”（AWaRe）抗生素分类系统对抗生素处方进行了分类。
我们最终的299名患者队列中，女性占44%，有27%暴露于艾滋病毒；大多数（68%）入住普通儿科病房。感染是29%的队列住院的常见原因。几乎一半的队列患者在住院期间至少开具了一种抗生素，其中40%在入院时开具；这些处方中几乎一半（47%）被认为是合理的。出院时，52名（21%）患者开具了抗生素，其中37%是合理的。在所有开具的抗生素中，42%来自世界卫生组织的“获取”抗生素清单，58%来自“观察”抗生素清单，0%来自“限制”抗生素清单。单因素分析显示，外科患者入院时开具不适当抗生素的可能性显著更高。接受有临床路径的疾病治疗的患者，或入院时进行了血培养的患者，开具不适当抗生素的可能性较小。多因素分析显示，除了入住外科病房外，没有独立的不合理抗生素使用预测因素，尽管重症患者有接受不合理抗生素治疗的趋势。
我们的研究显示抗生素消耗量很高，其中许多是不合理的。抗菌药物管理干预的有前景领域包括：（1）儿科外科人群管理方法的标准化；（2）在这家三级医疗机构实施可行且可推广的临床路径。
