Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

Donà, Daniele; Luise, Dora; Barbieri, Elisa; Masiero, Nicola; Maita, Sonia; Antoniello, Luca Maria; Zaoutis, Theoklis E.; Giaquinto, Carlo; Gamba, Piergiorgio

doi:10.3390/pathogens9060490

Cited by 17 publications

(16 citation statements)

References 16 publications

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“…Stewardship policy implementation has also proved to make a difference in reducing inappropriate prescribing. In a setting where the main challenges are represented by high patient turnover rates and diagnostic uncertainty in empiric prescription, clinical pathways, a one-page decision support algorithm summarizing the guidelines, could be a valid tool to assist prescribers in defining the diagnosis and the most appropriate treatment 46 , 47 .…”

Section: Discussionmentioning

confidence: 99%

Impact of bronchiolitis guidelines publication on primary care prescriptions in the Italian pediatric population

Barbieri

Cantarutti

Cavagnis

et al. 2021

npj Prim. Care Respir. Med.

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In Italy, two clinical practice guidelines for the diagnosis and treatment of bronchiolitis were published in October 2014 and December 2015. We evaluated prescriptions for bronchiolitis in children aged 0–24 months before (December 2012–December 2014), in between (December 2014–December 2015) and after (December 2015–December 2018) the guidelines publications. Data were retrieved from the Pedianet database; the measured outcomes were prescriptions rates of antibiotics, corticosteroids, β2-agonists, and other respiratory drugs. In 1011 out of 1581 episodes, patients received at least one treatment, with a total of 2003 prescriptions. The rate of treated bronchiolitis decreased from 66% to 57% (p < 0.001) after the publication of the second guideline; the highest reduction was in younger patients (from 57% to 44%, p = 0.013). Overall antibiotic prescriptions rate did not change, with 31.6% of the patients still receiving them. Our results confirm unnecessary non-evidence-based treatments in the primary care setting, with few changes after the guidelines publications.

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Section: Discussionmentioning

confidence: 99%

Impact of bronchiolitis guidelines publication on primary care prescriptions in the Italian pediatric population

Barbieri

Cantarutti

Cavagnis

et al. 2021

npj Prim. Care Respir. Med.

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“…Interestingly, in the periods immediately before and after 2019-CP, inpatient LOT was quasi-significantly lower than before 2015-CPs implementation value. It may be asserted that when a new policy is implemented, prescribers tend to check the guidelines more often, thus leaving fewer opportunities for mistakes [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

et al. 2021

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Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

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“…Studies have demonstrated that around 20 to 50% of antibiotic prescriptions are unnecessary or inappropriate [ 6 , 7 , 8 ], with patients have received broad-spectrum antibiotics for viral infections [ 9 , 10 ] or antibiotic treatment courses significantly longer than needed [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012–2018

et al. 2021

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Comprehensive data are needed to monitor antibiotic prescribing and inform stewardship. We aimed to evaluate the current antibiotic prescribing patterns, including treatment switching and prolongation, in the paediatric primary care setting in Italy. This database study assessed antibiotic prescriptions retrieved from Pedianet, a paediatric primary care database, from 1 January 2012 to 31 December 2018. Descriptive analyses were stratified by diagnosis class, calendar year, and children’s age. Generalized linear Poisson regression was used to assess variation in the prescriptions. In total, 505,927 antibiotic prescriptions were included. From 2012 to 2018, the number of antibiotics per child decreased significantly by 4% yearly from 0.79 in 2012 to 0.62 in 2018. Amoxicillin prescriptions decreased with increasing children’s age, while macrolides and third-generation cephalosporins had the opposite trend. Prescriptions were associated with a diagnosis of upper respiratory infection in 23% of cases, followed by pharyngitis (21%), bronchitis and bronchiolitis (12%), and acute otitis media (12%). Eight percent of treatment episodes were prolonged or switched class, mostly represented by co-amoxiclav, macrolides, and third-generation cephalosporins. Our findings report an overall decrease in antibiotic prescriptions, but pre-schoolers are still receiving more than one antibiotic yearly, and broad-spectrum antibiotics prescription rates remain the highest.

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Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

Cited by 17 publications

References 16 publications

Impact of bronchiolitis guidelines publication on primary care prescriptions in the Italian pediatric population

Impact of bronchiolitis guidelines publication on primary care prescriptions in the Italian pediatric population

Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012–2018

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