TY - JOUR T1 - Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription JO - Enfermedades Infecciosas y Microbiología Clínica (English Edition) T2 - AU - Goycochea-Valdivia,Walter Alfredo AU - Moreno-Ramos,Francisco AU - Paño-Pardo,José Ramón AU - Aracil-Santos,Francisco Javier AU - Baquero-Artigao,Fernando AU - del Rosal-Rabes,Teresa AU - Mellado-Peña,María José AU - Escosa-García,Luis SN - 2529993X M3 - 10.1016/j.eimce.2017.01.038 DO - 10.1016/j.eimce.2017.01.038 UR - https://www.elsevier.es/en-revista-enfermedades-infecciosas-microbiologia-clinica-english-428-articulo-identifying-priorities-improve-paediatric-in-hospital-S2529993X17302344 AB - IntroductionInformation about paediatric in-hospital antimicrobial usage and prescribing patterns to guide improvement strategies is scant. We aim to use an evaluation of the prevalence and appropriateness of antimicrobial prescription to identify antimicrobial stewardship priorities in children. MethodsA cross-sectional point study was performed on hospitalised paediatric patients in a Spanish tertiary hospital, assessing the prevalence of antimicrobial prescription (PAP) and appropriateness of antimicrobial prescription (AAP). AAP was defined as a correct indication plus an appropriate prescribing pattern (dose, spectrum and interval). Evaluation was performed using established antimicrobial guidelines. Other factors that may have a bearing on antimicrobial prescription were also analysed. ResultsA total of 171 patients were included. PAP was 49.7% (85/171) and AAP was 60.9% (91/161). The most common indications for antimicrobial use were antimicrobial prophylaxis (28.3%, 32/113) and pneumonia (8.2%, 8/113). Overall, 161 antimicrobials were prescribed (1.9 antimicrobials per patient): 55.3% (89/161) were empiric, 16.1% (26/161) were targeted and 28.6% (46/161) were prophylactic. Amoxicillin/clavulanate (8.2%, 14/171) and sulfamethoxazole/trimethoprim (8.2%, 14/171) were the most prescribed antimicrobials. The prescription of antifungals (11.7%, 20/171) and antivirals (1.8%, 3/171) was analysed. Major causes of inappropriate antibiotic use were prolonged prescriptions (21.7%, 35/161) and use of agents with an excessively broad coverage spectrum (21.1%, 34/161). PAP and AAP varied between wards and antimicrobials. ConclusionsMeasurement of PAP and AAP offers valuable information for detecting priorities in hospital settings and monitoring antimicrobial usage prior to the development of antimicrobial stewardship programmes. In our setting, the main areas for improvement are duration of therapy and proper use of broad-spectrum antimicrobials. ER -