Improving the Quality of Hospital Antibiotic Use: Impact on Multidrug-Resistant Bacterial Infections in Children

Abstract

Antimicrobial resistance (AMR) is considered a rapidly growing global public health emergency. Neonates and children are among patients for whom antibiotics are largely prescribed and for whom the risk of AMR development is high. The phenomenon of increasing AMR has led to the need to develop measures aimed at the rational and effective use of the available drugs also in children and antimicrobial stewardship (AS), which is one of the measures that in adults has showed the highest efficacy in reducing antibiotic abuse and misuse, appears as an attractive approach. The aim of this manuscript is to analyze the basic principles and strategies of pediatric AS. To this end, we searched in PubMed articles published in years 2000 to 2019 containing "antimicrobial resistance," "antibiotic use," "antimicrobial stewardship," and "children" or "pediatric" as keywords. Our review showed that the balance between multi-resistant organisms and new antimicrobials is extremely precarious. The AS tools are the most important weapon at our disposal to stem the phenomenon. Careful monitoring of prescriptions, continuous training of prescribing physicians and collaboration with highly qualified multidisciplinary staff, creation of local and national guidelines, use of rapid diagnostic tests, technological means of support, and research activities by testing new broad-spectrum antibiotics are mandatory. However, all of these measures must be supported by adequate investment by national and international health organizations. Only by making AS daily practice, through the use of financial resources and dedicated staff, we can fight AMR to ensure safe and effective care for our young patients.

Gut Microbiota and Obesity in Adults and Children: The State of the Art

“…Other external disruptors of host and gut microbiota symbiosis are represented by antibiotics. Antibiotics are the most prescribed and administered drug during infancy, due to the natural propensity of children to come into contact with new pathogens in order to develop their immune systems, some of them indirectly taken during intrauterine life (i.e., prophylaxis of vaginal group B Streptococcus and cesarean section delivery) or to prevent or treat bacterial infections typical of preterm infants ( 17 , 52 ). However, they must be administered judiciously for two reasons that both have a tremendous impact on public health: first, to delay or better stop the widespread problem of antibiotic resistance; second, because of their side effects that occur by acting also on the symbiotic bacteria of the human organism, including the gut microbiota ( 53 ).…”

Role of Artificial Intelligence in Fighting Antimicrobial Resistance in Pediatrics

“…In other cases, broad-spectrum antibiotics are prescribed at incorrect dosages or to treat infections for which targeted therapy is recommended. The emergence of multi-drug-resistant bacterial pathogens is thus strongly promoted, resulting in increased patient mortality, longer hospital stays, and higher health care costs [21].…”

“…Furthermore, the development of antibiotics is no longer considered an economically sensible investment for the pharmaceutical industry as antibiotics are used for relatively short periods of time, unlike drugs used to treat chronic diseases; the development costs of the latter are, among other things, much lower than those of antibiotics [22]. The result is that over the last 15 years, there have been significant deficiencies in the development and availability of new antibiotics to combat emerging resistance cases [21]. Implementation of containment strategies to address this rapidly growing problem, an effort called antimicrobial stewardship (AS), is therefore essential.…”

“…Implementation of containment strategies to address this rapidly growing problem, an effort called antimicrobial stewardship (AS), is therefore essential. These strategies have had a positive impact on adult patients, but only recently have they been used in the pediatric field [23], where, considering the heterogeneity in the age and weight of the patients, targeted interventions are needed [21]. As a consequence, the next section will report and discuss possible applications of artificial intelligence against AMR.…”

Telemedicine in Pediatric Infectious Diseases

“…Antimicrobial stewardship (AS) is a key element in improving the quality of hospital care. AS requires a multidisciplinary antimicrobial management team, including a prescribing physician, an infectious-disease specialist, a microbiologist and a pharmacist, to encourage accountability, drug competence, and the education of suppliers and patients [ 48 , 49 ].…”