Martin Perceval Lise, Wargny Matthieu, Benhamida Myriam, Dumortier Morgane, Gras-Le Guen Christèle, Navas Dominique, Launay Elise
Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 5: General Pediatrics Care Unit, F-44000 Nantes, France.
Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France.
Arch Pediatr. 2025 May;32(4):217-222. doi: 10.1016/j.arcped.2025.02.002. Epub 2025 Apr 7.
This work used a before-after study to evaluate the impact of a multifaceted stewardship intervention on the recommended duration of antibiotic treatment (5 vs 10 days) for non-severe community-acquired pneumonia (CAP) in pediatrics.
Children under age 15 years and 3 months who consulted for CAP in the emergency care unit of Nantes University Hospital from November 2019 to January 2020 and from December 2020 to April 2021 were included. Before the second period, the updated protocol was presented at a local meeting, sent by e-mail, and added to the internal network; physicians' knowledge was tested through clinical situations and answers to the questionnaire as well as pocket cards were distributed. The main outcome was the absolute and relative difference in prescription adequacy according to the recommended duration of antibiotic therapy (5 days) before and after the intervention.
We included 134 children: 71 and 63 before and after the intervention respectively. The proportion of adequate duration of antibiotic therapy prescribed was increased: 27 (38.0 %) children in the "before" group versus 50 (79.4 %) in the "after" group (p < 0.0001). The prescription adequacy ratio (after/before) was 2.09 (95 %CI, 1.51-2.88). The mean treatment duration was significantly higher in the "before" than "after" group: 7.3 versus 5.7 days (p < 0.0001). A total of 155 days of treatment per 100 treated children was avoided. The proportion of correctly prescribed dosages was higher in the "after" than the "before" group: + 18 % (p = 0.03). The proportion of nasopharyngeal PCR tests performed was significantly higher after than before the intervention (p < 0.0001). Chest X-rays were performed in almost all children in both groups.
This multifaceted stewardship intervention demonstrated clinically and statistically significant results concerning the prescribed antibiotic therapy duration at individual and population levels and could be extended to other care centers and other situations.
本研究采用前后对照研究，评估多方面管理干预措施对儿科非重症社区获得性肺炎（CAP）抗生素治疗推荐疗程（5天与10天）的影响。
纳入2019年11月至2020年1月以及2020年12月至2021年4月在南特大学医院急诊科因CAP就诊的15岁3个月以下儿童。在第二阶段之前，更新后的方案在当地会议上进行了介绍，通过电子邮件发送，并添加到内部网络；通过临床病例和问卷答案测试医生的知识，并分发袖珍卡片。主要结局是干预前后根据抗生素治疗推荐疗程（5天）的处方适当性的绝对和相对差异。
我们纳入了134名儿童，干预前71名，干预后63名。规定的抗生素治疗适当疗程比例有所增加：“干预前”组有27名（38.0%）儿童，“干预后”组有50名（79.4%）儿童（p<0.0001）。处方适当率（干预后/干预前）为2.09（95%CI，1.51 - 2.88）。“干预前”组的平均治疗疗程显著高于“干预后”组：7.3天对5.7天（p<0.0001）。每100名接受治疗的儿童共避免了155天的治疗。“干预后”组正确规定剂量的比例高于“干预前”组：增加了18%（p = 0.03）。干预后进行鼻咽部PCR检测的比例显著高于干预前（p<0.0001）。两组几乎所有儿童都进行了胸部X光检查。
这种多方面管理干预在个体和人群层面的规定抗生素治疗疗程方面显示出临床和统计学上的显著结果，可扩展到其他护理中心和其他情况。
