Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Lestner, Jodi M.; Versporten, Ann; Doerholt, Katja; Warris, Adilia; Roilides, Emmanuel; Bielicki, Julia; Goossens, Herman

doi:10.1128/aac.04109-14

Cited by 43 publications

(50 citation statements)

References 30 publications

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“…In the setting of HSCT, the mortality rates of IFDs are 30‐40% for yeast infections and up to 70% for mold infections . A single‐day point prevalence study of antimicrobial use in Europe revealed that less than half of the children received antifungal drugs within the dosing range recommended in current guidelines, and subtherapeutic doses were prescribed in 47% of these children . These findings may contribute to suboptimal clinical outcomes and to an increased predominance of resistant fungi.…”

Section: Discussionmentioning

confidence: 99%

Effect of an intervention to improve the prescription of antifungals in pediatric hematology‐oncology

Santiago-García

Rincón-López

Salas

et al. 2019

Pediatric Blood & Cancer

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Background The use of antifungals has expanded in pediatric hematology‐oncology, and the need to develop pediatric‐based surveillance and education activities is becoming crucial. The aims of this study were to evaluate the impact of a multidisciplinary protocol on the adequacy of antifungal prescription in a pediatric hematology‐oncology unit and to assess the effect of an educational intervention to improve the knowledge of prescribing pediatricians over time. Methods A multidisciplinary team established a protocol for the management of invasive fungal disease (IFD). The use of antifungals before (January 2012‐May 2013) and after the protocol (June 2013‐December 2015) was evaluated. Prescribing pediatricians attended a training course on IFD and were evaluated before 0, 6, and 12 months after the intervention. Results During the study period, antifungal agents were used in 185 episodes (56 children, 39.3% females), and were administered as prophylaxis (58.9%), empiric (34.6%), or targeted therapy (6.5%). Antifungal prescriptions were inadequate in 7% of the episodes, related to drug selection (53.8%), dosage (38.5%) and route of administration (7.7%). After protocol implementation, inadequate prescriptions decreased 9.9% (15.2% vs 5.3%; P = .04). Following the educational activity, the percentage of adequate responses to the questionnaire improved significantly compared to baseline, and persisted over time (19.7% improvement at 0 months [P < .0001]; 21.1% at 6 months [P < .0001]; 16.6% at 12 months [P = .002]). Conclusions The establishment of multidisciplinary protocols and education activities improved the quality of antifungal prescription and the knowledge of prescribers regarding antifungal therapy. Therefore, these activities may be important for the implementation of antifungal stewardship programs in pediatrics.

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Section: Discussionmentioning

confidence: 99%

Effect of an intervention to improve the prescription of antifungals in pediatric hematology‐oncology

Santiago-García

Rincón-López

Salas

et al. 2019

Pediatric Blood & Cancer

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“…Repeated PPS 33 needs to be part of the paediatric antibiotic stewardship strategy in order to identify prescribing trends over time, to evaluate the efficacy of ASPs and to tackle the issue of suboptimal antibiotic use, especially on antibiotic dosing. 34 International standardised PPS with further linkage between antibiotic prescribing and resistance will be critical to characterise appropriate use of antibiotics in hospitalised children globally and to propose guidance on the management of paediatric infections taking into account resistance profiles.…”

Section: Discussionmentioning

confidence: 99%

Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK

et al. 2016

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BackgroundThe National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.MethodsWe conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.ResultsA total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.ConclusionsWe provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.

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“…Hospitalized patients receiving these agents demand closer scrutiny to improve patient outcomes and potentially reduce hospital expenditures. 2 The 2016 Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America ASP guidelines recommend that stewardship should expand to include antifungal therapy. 3 Although prescribing trends of antifungal and antiviral drugs among children are relatively unknown, data suggest that their use is increasing.…”

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confidence: 99%

Variability in Antifungal and Antiviral Use in Hospitalized Children

Goldman

Ross

Lee

et al. 2017

Infect. Control Hosp. Epidemiol.

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Systemic Antifungal Prescribing in Neonates and Children: Outcomes from the Antibiotic Resistance and Prescribing in European Children (ARPEC) Study

Cited by 43 publications

References 30 publications

Effect of an intervention to improve the prescription of antifungals in pediatric hematology‐oncology

Effect of an intervention to improve the prescription of antifungals in pediatric hematology‐oncology

Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK

Variability in Antifungal and Antiviral Use in Hospitalized Children

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