Brigadoi Giulia, Rossin Sara, Chiusaroli Lorenzo, Demarin Giulia Camilla, Maestri Linda, Tesser Francesca, Matarazzo Martina, Liberati Cecilia, Barbieri Elisa, Giaquinto Carlo, Da Dalt Liviana, Bressan Silvia, Donà Daniele
Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy.
Pediatric Emergency Department, Department of Women's and Children's Health, Padua University Hospital, 35128 Padua, Italy.
Children (Basel). 2024 Oct 30;11(11):1325. doi: 10.3390/children11111325.
Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years.
We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014-September 2015), post-implementation (October 2015-March 2020), and COVID-19 (April 2020-August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed.
The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time.
The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance.
皮肤和软组织感染（SSTIs）是儿童常见的感染综合征。广谱抗生素的过度使用导致抗生素耐药性上升，使治疗结果复杂化。为解决这一问题，已实施抗菌药物管理计划（ASPs）以优化抗生素使用。本研究评估了多方面的抗菌药物管理计划在八年时间里对儿科急性护理环境中SSTIs抗生素处方实践的影响。
我们在帕多瓦大学医院儿科急性护理病房进行了一项准实验研究，纳入了2014年10月至2022年9月因SSTIs入院的儿童，以评估2015年10月实施的多方面抗菌药物管理计划的影响。该研究分为三个阶段：实施前（2014年10月至2015年9月）、实施后（2015年10月至2020年3月）和新冠疫情期间（2020年4月至2022年8月）。收集并分析了抗生素处方和微生物学结果的数据。
抗菌药物管理计划的实施导致广谱抗生素的使用显著减少，尤其是第三代头孢菌素（从40.4%降至9.8%）和糖肽类抗生素（从21.1%降至1.6%）。可及性抗生素的处方显著增加，从实施前的30%增加到实施后的60%以上，在新冠疫情期间达到80%。未观察到住院时间增加。微生物学结果显示细菌谱随时间无显著变化。
抗菌药物管理计划的使用有效改善了抗生素处方实践，即使在新冠疫情期间也减少了对广谱抗生素的依赖。这些发现凸显了持续管理努力的价值，并表明门诊环境需要类似计划以进一步应对抗生素耐药性问题。
