Brigadoi Giulia, Liberati Cecilia, Gres Emelyne, Barbieri Elisa, Boreggio Elena, Rossin Sara, Tirelli Francesca, Tesser Francesca, Chiusaroli Lorenzo, Demarin Giulia Camilla, Maestri Linda, Giaquinto Carlo, Da Dalt Liviana, Bressan Silvia, Donà Daniele
Division of Pediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padova 35128, Italy.
Division of Pediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padova, Italy.
Ther Adv Infect Dis. 2024 Oct 30;11:20499361241282824. doi: 10.1177/20499361241282824. eCollection 2024 Jan-Dec.
Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented.
The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center.
This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021.
Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes.
During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria.
The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.
尿路感染（UTIs）是儿童最常见的细菌感染。病原体易感性率的高度变异性导致缺乏明确的经验性和靶向性治疗指南。鉴于此，需要开展当地微生物监测和因地制宜的管理干预措施。
本研究旨在描述在一家三级中心的儿科普通病房中，一项为期8年的儿科抗菌药物管理计划对UTIs抗生素处方的影响结果。
这项准实验研究于2015年至2022年期间进行，有两次不同的实施阶段，一次在2018年，一次在2021年。
从纳入患者的电子临床记录中检索人口统计学、临床、微生物学和治疗数据。主要结局是遵循当地经验性治疗指南的情况以及靶向治疗的充分性。次要结局是评估住院期间和出院时按抗生素分层的抗生素处方模式，以及评估UTIs发作的微生物学特征。
在研究期间，7038名患者入住儿科急性护理病房（PACU），其中264名（3.7%）纳入本研究。干预后立即对当地指南的遵循情况最高，此后略有下降。在整个8年期间，头孢菌素的使用仍然很高，但观察到的微生物学情况变化导致研究期间的建议发生了变化。近年来，对阿莫西林克拉维酸耐药的菌株有所增加。口服二线药物的消耗量仍然很高，但考虑到耐药菌的流行情况是足够的。
抗菌药物消费的变异性反映了UTIs病原体耐药模式的变化，这突出了因地制宜、持续开展抗菌药物管理干预措施的重要性。
