In reply to: “Antimicrobial defined daily dose adjusted by weight: A proposal for antibiotic consumption measurement in children”

Goycochea-Valdivia, Walter-Alfredo; Montecatine-Alonso, Elena; Gil-Navarro, María-Victoria; Neth, Olaf

doi:10.1016/j.eimce.2019.01.004

Cited by 1 publication

(3 citation statements)

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“…There is high variability in the methodology used and there are no harmonised quality endpoints, which are urgently required 1 4 24. Moreover, the optimal metric for aggregate AMC measurement is not yet determined for paediatrics 24–26. While days of therapy (DOT) have been replacing DDD as the preferred metric for children granted that they are not affected by weight-dosing variations, it does not discern between antibiotic spectrum of activity 24–26.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the optimal metric for aggregate AMC measurement is not yet determined for paediatrics 24–26. While days of therapy (DOT) have been replacing DDD as the preferred metric for children granted that they are not affected by weight-dosing variations, it does not discern between antibiotic spectrum of activity 24–26. Some authors have proposed the use of more than one metric for paediatric patients, but this seems unpractical on daily basis 25 26.…”

Section: Discussionmentioning

confidence: 99%

“…While days of therapy (DOT) have been replacing DDD as the preferred metric for children granted that they are not affected by weight-dosing variations, it does not discern between antibiotic spectrum of activity 24–26. Some authors have proposed the use of more than one metric for paediatric patients, but this seems unpractical on daily basis 25 26. Our centre uses DDD as the metric to evaluate AMC in both adults and children, but efforts are currently underway to calculate DOT.…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcomes of an educational paediatric antimicrobial stewardship programme: a quality improvement study

Aboza Garcia,

Goycochea-Valdivia,

Peñalva

et al. 2023

Arch Dis Child

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Background and objectivesAntimicrobial stewardship programmes (ASPs) have resulted in antimicrobial consumption (AMC) reduction and quality of prescription (QOP) improvement. However, evidence of ASP impact in paediatrics is still limited. This study aims to assess a paediatric ASP long-term outcomes.MethodsA quality improvement study assessed by a interrupted time series analysis was conducted in a paediatric tertiary hospital. QOP expressed as proportion of adequate prescriptions, AMC measured by defined daily dose incidence per 1000 occupied bed days, incidence density of bloodstream infections (BSIs) and its related all-cause crude death rate (CDR) were compared between pre (from January 2013 to December 2015) and post (from January 2016 to December 2019) ASP activities intensification, which included a dedicated paediatric infectious diseases physician to actively perform educational interviews with prescribers.ResultsInappropriate prescribing showed a significant downward shift associated to the intervention with a −51.4% (−61.2% to −41.8%) reduction with respect to the expected values. Overall AMC showed no trend change after the intervention. For neonatology a28.8% (−36.8% to −20.9%) reduction was observed. Overall anti-pseudomonal cephalosporin use showed a −51.2% (−57.0% to −45.4%) reduction. Decreasing trends were observed for carbapenem use, with a quarterly per cent change (QPC) of −2.4% (−4.3% to −0.4%) and BSI-related CDR (QPC=−3.6%; −5.4% to −1.7%) through the study period. Healthcare-associated multi-drug-resistant BSI remained stable (QPC=2.1; −0.6 to 4.9).ConclusionsIntensification of counselling educational activities within an ASP suggests to improve QOP and to partially reduce AMC in paediatric patients. The decreasing trends in mortality remained unchanged.

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Section: Discussionmentioning

confidence: 99%