Antimicrobial stewardship in paediatrics
Tóm tắt
Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed. Over the last few years, there have been significant shortages in the development and availability of new antibiotics; therefore, the implementation of strategies to preserve the activity of existing antimicrobial agents has become an urgent public health priority. AS is one such approach. The need for formal AS programs in paediatrics was officially recognized only recently, considering the widespread use of antibiotics in children and the different antimicrobial resistance patterns that these subjects exhibit in comparison to adult and elderly patients. However, not all problems related to the implementation of AS programs among paediatric patients are solved. The most important remaining problems involve educating paediatricians, creating a multidisciplinary interprofessional AS team able to prepare guidelines, monitoring antibiotic prescriptions and defining corrective measures, and the availability of administrative consensuses with adequate financial support. Additionally, the problem of optimizing the duration of AS programs remains unsolved. Further studies are needed to solve the above mentioned problems. In paediatric patients, as in adults, the successful implementation of AS strategies has had a significant impact on reducing targeted- and nontargeted-antimicrobial use by improving the quality of care for hospitalized patients and preventing the emergence of resistance. Considering that rationalization of antibiotic misuse and abuse is the basis for reducing emergence of bacterial resistance and several clinical problems, all efforts must be made to develop multidisciplinary paediatric AS programs in hospital and community settings.
Tài liệu tham khảo
Gerber JS, Newland JG, Coffin SE, Hall M, Thurm C, Prasad PA, Feudtner C, Zaoutis TE. Variability in antibiotic use at children’s hospitals. Pediatrics. 2010;126:1067–73.
Ashiru-Oredope D, Hopkins S, English Surveillance Programme for Antimicrobial Utilization and Resistance Oversight Group. Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). J Antimicrob Chemother. 2013;68:2421–3.
Spyridis N, Syridou G, Goossens H, Versporten A, Kopsidas J, Kourlaba G, Bielicki J, Drapier N, Zaoutis T, Tsolia M, Sharland M, ARPEC Project Group Members. Variation in paediatric hospital antibiotic guidelines in Europe. Arch Dis Child. 2016;101:72–6.
Levy ER, Swami S, Dubois SG, Wendt R, Banerjee R. Rates and appropriateness of antimicrobial prescribing at an academic children’s hospital, 2007–2010. Infect Control Hosp Epidemiol. 2012;33:346–53.
Pakyz AL, Gurgle HE, Ibrahim OM, Oinonen MJ, Polk RE. Trends in antibacterial use in hospitalized pediatric patients in United States academic health centers. Infect Control Hosp Epidemiol. 2009;30:600–3.
Grohskopf LA, Huskins WC, Sinkowitz-Cochran RL, Levine GL, Goldmann DA, Jarvis WR. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J. 2005;24:766–73.
Rutledge-Taylor K, Matlow A, Gravel D, Embree J, Le Saux N, Johnston L, Suh K, Embil J, Henderson E, John M, Roth V, Wong A, Shurgold J, Taylor G, Canadian Nosocomial Infection Surveillance Program. Canadian Nosocomial Infection Surveillance Program: a point prevalence survey of health care-associated infections in Canadian pediatric inpatients. Am J Infect Control. 2012;40:491–6.
Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H; ARPEC project group. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016, Epub Jan 8.
Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128:1053–61.
Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med. 2002;156:1114–9.
McCaig LF, Besser RE, Hughes JM. Antimicrobial drug prescription in ambulatory care settings, United States, 1992–2000. Emerg Infect Dis. 2003;9:432–7.
Esposito S, Blasi F, Allegra L, Principi N, Mowgli Study Group. Use of antimicrobial agents for community-acquired lower respiratory tract infections in hospitalised children. Eur J Clin Microbiol Infect Dis. 2001;20:647–50.
Porta A, Hsia Y, Doerholt K, Spyridis N, Bielicki J, Menson E, Tsolia M, Esposito S, Wong IC, Sharland M. Comparing neonatal and paediatric antibiotic prescribing between hospitals: a new algorithm to help international benchmarking. J Antimicrob Chemother. 2012;67:1278–86.
Graham SM, Bell DJ, Nyirongo S, Hartkoorn R, Ward SA, Molyneux EM. Low levels of pyrazinamide and ethambutol in children with tuberculosis and impact of age, nutritional status, and human immunodeficiency virus infection. Antimicrob Agents Chemother. 2006;50:407–13.
Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and healthcare costs. Clin Infect Dis. 2006;42 Suppl 2:S82–B89.
Maragakis LL, Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther. 2008;6:751–63.
Kociolek LK, Patel SJ, Zheng X, Todd KM, Shulman ST, Gerding DN. Clinical and microbiologic assessment of cases of pediatric community-associated Clostridium difficile infection reveals opportunities for improved testing decisions. Pediatr Infect Dis J. 2016;35:157–61.
Pant C, Deshpande A, Gilroy R, Olyaee M, Donskey CJ. Rising Incidence of Clostridium difficile related discharges among hospitalized children in the United States. Infect Control Hosp Epidemiol. 2016;37:104–6.
Tagliabue C, Principi N, Giavoli C, Esposito S. Obesity: impact of infections and response to vaccines. Eur J Clin Microbiol Infect Dis. 2015, Epub Dec 30.
Vangay P, Ward T, Gerber JS, Knights D. Antibiotics, pediatric dysbiosis, and disease. Cell Host Microbe. 2015;17:553–64.
Magsarili HK, Girotto JE, Bennett NJ, Nicolau DP. Making a case for pediatric antimicrobial stewardship programs. Pharmacotherapy. 2015;35:1026–36.
Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, Scheld M, Spellberg B, Bartlett J. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:1–12.
Transatlantic Taskforce on Antimicrobial Resistance: Progress report May 2014. Recommendations for future collaboration between the US and EU. Available at: http://www.cdc.gov/drugresistance/pdf/tatfar-progress_report_2014.pdf. Accessed on: 18 Jan 2016.
Newland JG, Hersh AL. Purpose and design of antimicrobial stewardship programs in pediatrics. Pediatr Infect Dis J. 2010;29:862–3.
Dellit TH, Owens RC, McGowan Jr JE, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM, Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Clin Infect Dis. 2007;44:159–77.
Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol. 2012;33:322–7.
Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Redbook: 2015 Report of the Committee on Infectious Disease(16)s. 30th ed. Elk Grove Village: American Academy of Pediatrics; 2015.
Bielicki J, Lundin R, Patel S, Paulus S. Antimicrobial stewardship for neonates and children. Pediatr Infect Dis. 2015;34:311–2.
Goldman JL, Lee BR, Hersh AL, Yu D, Stach LM, Myers AL, Jackson MA, Day JC, McCulloh RJ, Newland JG. Clinical diagnoses and antimicrobials predictive of pediatric antimicrobial stewardship recommendations: a program evaluation. Infect Control Hosp Epidemiol. 2015;36:673–80.
Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev. 2005;4, CD003539.
Principi N, Esposito S. Antigen-based assays for the identification of influenza virus and respiratory syncytial virus: why and how to use them in pediatric practice. Clin Lab Med. 2009;29:649–60.
Bielicki JA, Sharland M, Johnson AP, Henderson KL, Cromwell DA. Antibiotic Resistance and Prescribing in European Children project: Selecting appropriate empirical antibiotic regimens for paediatric bloodstream infections: application of a Bayesian decision model to local and pooled antimicrobial resistance surveillance data. J Antimicrob Chemother. 2015, Epub Nov 30.
Esposito S, Principi N. Emerging resistance to antibiotics against respiratory bacteria: impact on therapy of community-acquired pneumonia in children. Drug Resist Updat. 2002;5:73–87.
Hyun DY, Hersh AL, Namtu K, Palazzi DL, Maples HD, Newland JG, Saiman L. Antimicrobial stewardship in pediatrics: how every pediatrician can be a steward. JAMA Pediatr. 2013;167:859–66.
Bryant PA, Australasian Stewardship of Antimicrobials in Paediatrics group. Antimicrobial stewardship resources and activities for children in tertiary hospitals in Australasia: a comprehensive survey. Med J Aust. 2015;202:134–8.
Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, Townsend T, Lehmann CU. A world wide web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008;47:747–53.
Metjian TA, Prasad PA, Kogon A, Coffin SE, Zaoutis TE. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J. 2008;27:106–11.
Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric antimicrobial stewardship program at a children's hospital. Pediatrics. 2011;128:1062–70.
Hersh AL, De Lurgio SA, Thurm C, Lee BR, Weissman SJ, Courter JD, Brogan TV, Shah SS, Kronman MP, Gerber JS, Newland JG. Antimicrobial stewardship programs in freestanding children's hospitals. Pediatrics. 2015;135:33–9.
Finkelstein JA, Huang SS, Kleinman K, Rifas-Shiman SL, Stille CJ, Daniel J, Schiff N, Steingard R, Soumerai SB, Ross-Degnan D, Goldmann D, Platt R. Impact of a 16-community trial to promote judicious antibiotic use in Massachusetts. Pediatrics. 2008;121:e15–23.
Gerber JS, Prasad PA, Fiks AG, Localio AR, Grundmeier RW, Bell LM, Wasserman RC, Keren R, Zaoutis TE. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309:2345–52.
2014 Sweders Swarm. Consumption of antibiotics and occurrence of antibiotic resistance in Sweden. Available at: http://www.folkhalsomyndigheten.se/pagefiles/20281/Swedres-Svarm-2014-14027.pdf Accessed on: 19 Jan 2016.
Bowes J, Yasseen 3rd AS, Barrowman N, Murchison B, Dennis J, Moreau KA, Varughese N, Le Saux N. Antimicrobial stewardship in pediatrics: focusing on the challenges clinicians face. BMC Pediatr. 2014;14:212.
Stevenson KB, Balada-Llasat JM, Bauer K, Deutscher M, Goff D, Lustberg M, Pancholi P, Reed E, Smeenk D, Taylor J, West J. The economics of antimicrobial stewardship: the current state of the art and applying the business case model. Infect Control Hosp Epidemiol. 2012;33:389–97.
Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51–77.
De Luca M, Donà D, Montagnani C, Lo Vecchio A, Romanengo M, Tagliabue C, Centenari C, D'Argenio P, Lundin R, Giaquinto C, Galli L, Guarino A, Esposito S, Sharland M, Versporten A, Goossens H, Nicolini G. Antibiotic prescriptions and prophylaxis in Italian children. Is it time to change? Data from the ARPEC project. PLoS One. 2016;11, e0154662.
Chiappini E, Principi N, Mansi N, Serra A, De Masi S, Camaioni A, Esposito S, Felisati G, Galli L, Landi M, Speciale AM, Bonsignori F, Marchisio P, de Martino M, Italian Panel on the Management of Pharyngitis in Children. Management of acute pharyngitis in children: summary of the Italian National Institute of Health guidelines. Clin Ther. 2012;34:1442–58.
Chiappini E, Camaioni A, Benazzo M, Biondi A, Bottero S, De Masi S, Di Mauro G, Doria M, Esposito S, Felisati G, Felisati D, Festini F, Gaini RM, Galli L, Gambini C, Gianelli U, Landi M, Lucioni M, Mansi N, Mazzantini R, Marchisio P, Marseglia GL, Miniello VL, Nicola M, Novelli A, Paulli M, Picca M, Pillon M, Pisani P, Pipolo C, Principi N, Sardi I, Succo G, Tomà P, Tortoli E, Tucci F, Varricchio A, de Martino M, Italian Guideline Panel For Management Of Cervical Lymphadenopathy In Children. Development of an algorithm for the management of cervical lymphadenopathy in children: consensus of the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Society of Pediatric Infectious Diseases and the Italian Society of Pediatric Otorhinolaryngology. Expert Rev Anti Infect Ther. 2015;13:1557–67.
Chiappini E, Mazzantini R, Bruzzese E, Capuano A, Colombo M, Cricelli C, Di Mauro G, Esposito S, Festini F, Guarino A, Miniello VL, Principi N, Marchisio P, Rafaniello C, Rossi F, Sportiello L, Tancredi F, Venturini E, Galli L, de Martino M. Rational use of antibiotics for the management of children's respiratory tract infections in the ambulatory setting: an evidence-based consensus by the Italian Society of Preventive and Social Pediatrics. Paediatr Respir Rev. 2014;15:231–6.
Gerber JS, Prasad PA, Fiks AG, Localio AR, Bell LM, Keren R, Zaoutis TE. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA. 2014;312:2569–70.