Liberati C, Brigadoi G, Gres E, Barbieri E, Cavagnero F, Maestri L, Trivellato S, Zenere A, De Pieri M, Di Chiara C, Mengato D, Venturini F, De Canale E, Del Vecchio C, Tessari A, Tosoni A, Zaggia C, Contessa C, Giaquinto C, Carrara E, Tacconelli E, Amigoni A, Donà D
Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy.
Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padova, Padova, Italy.
J Hosp Infect. 2025 Jun;160:53-59. doi: 10.1016/j.jhin.2025.02.010. Epub 2025 Mar 1.
Patients admitted to the paediatric intensive care unit (PICU) constitute a high-risk group with increased likelihood of receiving inappropriate antimicrobial prescriptions. This study describes an antimicrobial stewardship programme (ASP) in the PICU of a tertiary hospital in Italy.
A pre-post quasi-experimental study was conducted between 1 January 2019 and 31 December 2022 in the PICU of the Department for Women's and Children's Health, University Hospital of Padova. The ASP intervention was implemented in February 2021 by a multi-disciplinary team using the 'handshake' approach. The population included all patients admitted to the PICU. The primary outcome was antibiotic consumption measured as days of therapy administered (DOTs)/1000 patient-days. An interrupted time series analysis was used to assess trends in antibiotic prescribing before and after the intervention.
In total, 616 patients (episodes) were admitted in the pre-intervention phase (January 2019-January 2021) and 602 patients were admitted in the post-intervention phase (February 2021-December 2022). Implementation of the ASP resulted in a significant decrease in overall antibiotic consumption by 3.0% every month (P<0.0001). Monthly reductions in higher consumption antibiotics were: meropenem, 4.9% (P=0.009); glycopeptides, 3.8% (P=0.014); and piperacillin-tazobactam 4.8% (P=0.034). The consumption of third-generation cephalosporins and amikacin did not change significantly.
The ASP intervention was effective in reducing the consumption of antimicrobials in this complex setting. These results show the importance of antimicrobial stewardship in the scenario of critically ill children.
入住儿科重症监护病房（PICU）的患者构成了一个高危群体，接受不适当抗菌药物处方的可能性增加。本研究描述了意大利一家三级医院PICU的抗菌药物管理计划（ASP）。
2019年1月1日至2022年12月31日期间，在帕多瓦大学医院妇女和儿童健康部的PICU进行了一项前后对照的准实验研究。2021年2月，一个多学科团队采用“握手”方法实施了ASP干预措施。研究对象包括所有入住PICU的患者。主要结局指标是以给药天数（DOTs）/1000患者日衡量的抗生素消耗量。采用中断时间序列分析来评估干预前后抗生素处方的趋势。
在干预前阶段（2019年1月至2021年1月），共收治616例患者（病例），干预后阶段（2021年2月至2022年12月）收治602例患者。ASP的实施使总体抗生素消耗量每月显著下降3.0%（P<0.0001）。高消耗量抗生素的每月降幅分别为：美罗培南4.9%（P=0.009）；糖肽类3.8%（P=0.014）；哌拉西林-他唑巴坦4.8%（P=0.034）。第三代头孢菌素和阿米卡星的消耗量没有显著变化。
在这种复杂情况下，ASP干预措施在减少抗菌药物消耗方面是有效的。这些结果表明了抗菌药物管理在危重症儿童治疗中的重要性。
