Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018

Abstract

Background Antimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals. Methods Acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd). Results Nine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409–554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd). Conclusions This study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.

Antibiotic Exposure of Critically Ill Children at a Tertiary Care Paediatric Intensive Care Unit in Switzerland

“…In this study, we found the age group with the highest antibiotic exposure to be 0–1 month, with a rate of 72.7 DOT/100pd. Interestingly, in contrast to our findings, other studies mentioned earlier with specific NICU data [ 30 , 32 ] reported antibiotic use in the NICU not exceeding that of their PICU data. NICU wards with higher levels of specialization often report a higher use of antimicrobials, reflecting the complexity of cases treated, including higher rates of complications, severity of illness, and elevated infection risk in extremely premature neonates [ 30 ].…”

“…Interestingly, in contrast to our findings, other studies mentioned earlier with specific NICU data [ 30 , 32 ] reported antibiotic use in the NICU not exceeding that of their PICU data. NICU wards with higher levels of specialization often report a higher use of antimicrobials, reflecting the complexity of cases treated, including higher rates of complications, severity of illness, and elevated infection risk in extremely premature neonates [ 30 ]. Further, our cohort included nearly 50% postinterventional or postsurgical patients, who require postoperative antibiotic prophylaxis for 1–5 days, depending on the intervention.…”

“…A study of nine Canadian hospitals reported an overall paediatric (PICU, NICU, and non-ICU wards) antibiotic exposure of 48.1 DOT/100pd in 2017 and 2018. In that study, antibiotic use was found to be 33.3 DOT/100pd for NICU patients, 49.4 DOT/100pd for the general paediatric wards, and 78.4 DOT/100pd for PICU patients [ 30 ]. An Italian study, including all paediatric patients hospitalized in four hospitals in 2016, reported 47.2 DOT/100pd [ 31 ].…”

Extended Spectrum β-Lactamase-Producing Enterobacterales of Shrimp and Salmon Available for Purchase by Consumers in Canada—A Risk Profile Using the Codex Framework

“…Finally, a 2017/18 AMU survey of pediatric inpatients within the CNISP hospital network revealed that 3GCs were the antimicrobial class with the highest use (84 days of therapy/1000 patient-days) and this has remained relatively constant since 2017. This is followed closely by extended-spectrum penicillins (80 days of therapy/1000 patient-days) [ 150 ].…”