Liberati Cecilia, Brigadoi Giulia, Barbieri Elisa, Giaquinto Carlo, Donà Daniele
Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, 35128 Padua, Italy.
Antibiotics (Basel). 2025 Jan 26;14(2):130. doi: 10.3390/antibiotics14020130.
: We aimed to summarize the current state of antimicrobial stewardship (ASP) and diagnostic stewardship programs (DSPs) implemented in pediatric intensive care units (PICUs). : Embase, MEDLINE, Scopus and the Cochrane Library were searched, including studies from 1 January 2007 to 20 February 2024. Studies were included in the review if they assessed the implementation of an ASP or a DSP in a PICU. Identified references were downloaded into Rayyan software, and data were extracted using a standardized data collection form. : 18 studies were included; 13 described an ASP intervention, and 5 described a diagnostic stewardship intervention. Most studies were retrospective and adopted a persuasive strategy for ASP, reporting positive effects on antimicrobial consumption. However, studies were dramatically heterogeneous in terms of intervention type, outcomes and metrics used, limiting the possibility of a broader comparison. Diagnostic stewardship studies included mainly the impact of biomarkers and pathogen testing panels without significant impact on antibiotic prescription patterns. Antimicrobial resistance changes were not described by the majority of studies. : the implementation of ASP in PICUs is still limited, with significant variability in the metrics used to evaluate outcomes. To enhance the effectiveness of these programs, it is crucial to harmonize reporting metrics to allow an adequate comparison of results and to find the best strategies to inform ASP in PICUs.
我们旨在总结在儿科重症监护病房（PICU）实施的抗菌药物管理（ASP）和诊断管理计划（DSP）的现状。检索了Embase、MEDLINE、Scopus和Cochrane图书馆，包括2007年1月1日至2024年2月20日的研究。如果研究评估了PICU中ASP或DSP的实施情况，则纳入该综述。将识别出的参考文献下载到Rayyan软件中，并使用标准化的数据收集表提取数据。纳入了18项研究；13项描述了ASP干预，5项描述了诊断管理干预。大多数研究是回顾性的，对ASP采用了说服策略，报告了对抗菌药物使用的积极影响。然而，在干预类型、结果和使用的指标方面，研究存在显著异质性，限制了更广泛比较的可能性。诊断管理研究主要包括生物标志物和病原体检测面板的影响，对抗生素处方模式没有显著影响。大多数研究没有描述抗菌药物耐药性的变化。PICU中ASP的实施仍然有限，用于评估结果的指标存在显著差异。为了提高这些计划的有效性，统一报告指标以充分比较结果并找到为PICU中的ASP提供信息的最佳策略至关重要。
