High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results From the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey

Hufnagel, Markus; Versporten, Ann; Bielicki, Julia; Drapier, Nico; Sharland, Mike; Goossens, Herman; Omar, Abeer; Azmi, Aeshah Abdu Mubarak Al; Martinot, A.; Tagarro, Alfredo; Johnson, Alison; Bustinza, Amaya; Amina, Al-Jardani; Brett, Ana; Andrea, Lo Vecchio; Lunn, Andrew; Dramowski, Angela; McCORRY, A.; Enimil, Anthony; Rashed, Asia N; Soto, Beatriz; Santiago, Begoña; McCullagh, Bernadette; Gormley, Cairine; Giaquinto, Carlo; Lozano, Carlos Agustín González; Montagnani, Carlotta; Briquet, Caroline; Cooper, C; Centenari, Chiara; Barton, Christopher; Blyth, Christopher; Nash, Clare; Calvo, Cristina; Orbach, Daniel; Sharpe, David T.; Gkentzi, Despoina; Robbrecht, Dirk; Kalavalapalli, Durga Bhavani; Mozgis, Dzintars; Tamm, Eda; Cox, Elaine G.; Critselis, Elena; Borgia, Eleonora; Iosifidis, Εlias; Bell, Emily C.; Roilides, Emmanuel; Menson, Esse; Ladomenou, Fani; Rodrigues, Fernanda; Gahleitner, Florian; Tavchioska, Gabriela; Garg, Garima; Syridou, Garyfallia; Pouladfar, Gholamreza; Nicolini, Giangiacomo; Finlayson, Heather; Jansens, Hilde; Sviestiņa, Inese; Esteves, Isabel; Abubakar, Ismaela; Soltani, Jafar; AlAjmi, Jameela Ali; Al-Salman, Jameela; Aston, Jeff; Nielsen, Jens Peter; Petersen, J; Liese, Johannes G.; Alexander, John; Francis, Joshua; Garrahan, Juan P.; Clark, Julia; Pagava, Karaman; Mougkou, Katerina; Doerholt, Katja; Vilorio-Marqués, Laura; Jensen, Lise Heilmann; Renner, Lorna; Mahieu, Ludo; Galli, Luisa; Raka, Lul; Pluta, Magdalena; Heginbothom, Maggie; Luca, Maia De; Matsinen, Maire; Raman, Mala; Malviya, Manoj N; Awunyo, Marah; Laan, Mari; Knuf, Markus; Cancino, Martha E; Isa, Mas Suhaila; Lorrot, Mathie; Garbash, Mehdi; Borg, Michael; Kler, Neelam; Caldwell, Neil; Spyridis, Νikos; Ureta, Noelia; McMaster, Paddy; Garg, Pankaj; Gabriels, Patrick; Rossom, Paul Van; Barrero, Pedro Terol; Najdenov, Peter; Zarb, Peter; Lepage, Philippe; Maton, Pierre; Poorisrisak, Porntiva; Satodia, Prakash; Howe, Rachel; Gupta, Richa; Romain, Olivier; Tenconi, Rossana; Singh, Sanjeev; Chan, Si Min; Unuk, Sibila; Burokienė, Sigita; Drysdale, Simon B.; Cambrea, Simona Claudia; Kouni, Sofia; Blumental, Sophie; Murki, Srinivas; Kohlhoff, Stephan; Schlag, Stephanie A A; Sahu, Suneeta; Esposito, Susanna; Luck, Suzanne; Kovačević, Tanja; Singhal, Tanu; Zaoutis, Theoklis E.; Scorrer, Tim; Rajagopal, Veena; Gajdos, Vincent; Usonis, Vytautas; Vandewal, Wouter; Jafarpour, Zahra; Maskari, Zaina Al; Rubić, Žana; Hargadon-Lowe, Antonia; Rincón-López, Elena María; Al-Mousa, Haifaa H.; Maté-Cano, Irene; Saavedra-Lozano, Jesús; Rummukainen, Maija-Liisa; Prot-Labarthe, Sonia; Arenas-López, Sara; Escosa-García, Luis; Donà, Daniele; Maréchal, Flore Le; Čižman, Milan; Castañón, P. Zárate; D’Argenio, Patrizia

doi:10.1093/jpids/piy019

Cited by 44 publications

(36 citation statements)

References 11 publications

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“…A recent cross-sectional study reported that nearly one-third (32.9%) of European children's hospital inpatients received an antibiotic for prophylactic use (73.4% for medical diseases and 26.6% for surgical diseases). 16 Another study previously assessed antibiotic use in children admitted to hospitals participating in PHIS in 2008, before widespread implementation of inpatient antibiotic stewardship initiatives, and reported that~60% of hospitalized children received antibiotics at some point during their hospital stay as well as similar regional variability to that observed in our current study. 15 Differences in study design and measurement approaches likely account for some of the differences between the results of that study and our observed prevalence of 36.6%; our cross-sectional study focused on a single point-in-time assessment.…”

Section: Discussionsupporting

confidence: 80%

Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

Griffith

Dantuluri

Thurm

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:To characterize the prevalence of and seasonal and regional variation in inpatient antibiotic use among hospitalized US children in 2017–2018.Design:We conducted a cross-sectional examination of hospitalized children. The assessments were conducted on a single day in spring (May 3, 2017), summer (August 2, 2017), fall (October 25, 2017), and winter (January 31, 2018). The main outcome of interest was receipt of an antibiotic on the study day.Setting:The study included 51 freestanding US children’s hospitals that participate in the Pediatric Health Information System (PHIS).Patients:This study included all patients <18 years old who were admitted to a participating PHIS hospital, excluding patients who were admitted solely for research purposes.Results:Of 52,769 total hospitalized children, 19,174 (36.3%) received antibiotics on the study day and 6,575 of these (12.5%) received broad-spectrum antibiotics. The overall prevalence of antibiotic use varied across hospitals from 22.3% to 51.9%. Antibiotic use prevalence was 29.2% among medical patients and 47.7% among surgical patients. Although there was no significant seasonal variation in antibiotic use prevalence, regional prevalence varied, ranging from 32.7% in the Midwest to 40.2% in the West (P < .001). Among units, pediatric intensive care unit patients had the highest prevalence of both overall and broad-spectrum antibiotic use at 58.3% and 26.6%, respectively (P < .001).Conclusions:On any given day in a national network of children’s hospitals, more than one-third of hospitalized children received an antibiotic, and 1 in 8 received a broad-spectrum antibiotic. Variation across hospitals, setting and regions identifies potential opportunities for enhanced antibiotic stewardship activities.

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Section: Discussionsupporting

confidence: 80%

Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

Griffith

Dantuluri

Thurm

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Prophylaxis in pediatric surgical wards, however, accounted for 68.1% of antibiotic prescriptions. This was much higher than the percentage of antibiotic prophylaxis for surgical diseases in the treatment of children in Europe (26.6%) [ 29 ]. Also, 30% of the children in surgical wards in this study received two or more types of antibiotic prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

Gao

Guo

et al. 2020

BMC Infect Dis

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Background Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. Methods Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children’s Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. Results A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. Conclusions Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.

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“…gibt [15]. Mehr als die Hälfte aller operierten Kinder erhält statt einer einmaligen präoperativen Gabe eines Antibiotikums eine "PAP", die länger als 24 h verabreicht wird.…”

Section: Perioperative Antibiotikaprophylaxeunclassified

Antibiotic Stewardship (ABS) in der stationären Kinder- und Jugendmedizin

Simon¹,

Förster²,

Liese³

2021

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High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results From the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey

Abstract: A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.

Cited by 44 publications

References 11 publications

Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys

Antibiotic Stewardship (ABS) in der stationären Kinder- und Jugendmedizin

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