Australia-wide point prevalence survey of the use and appropriateness of antimicrobial prescribing for children in hospital

作者：Osowicki Joshua^*; Gwee Amanda; Noronha Jesuina; Pa****nthiran Pamela; McMullan Brendan; Britton Philip N; Isaacs David; Lai Tony; Nourse Clare; Avent Minyon; Moriarty Paul; Clark Julia; Francis Joshua R; Blyth Christopher C; Cooper Celia M; Bryant Penelope A

来源：Medical Journal of Australia, 2014, 201(11): 657-662.

DOI：10.5694/mja13.00154

Objectives: To describe antimicrobial use in hospitalised Australian children and to analyse the appropriateness of this antimicrobial use. %26lt;br%26gt;Design: Multicentre single-day hospital-wide point prevalence survey, conducted in conjunction with the Antimicrobial Resistance and Prescribing in European Children study. %26lt;br%26gt;Setting: Eight children%26apos;s hospitals across five Australian states, surveyed during late spring and early summer 2012. %26lt;br%26gt;Patients: Children and adolescents who were inpatients at 8 am on the day of the survey. %26lt;br%26gt;Main outcome measures: Quantity and quality of antimicrobial prescribing. %26lt;br%26gt;Results: Of 1373 patients, 631 (46%) were prescribed at least one antimicrobial agent, 198 (31%) of whom were %26lt;1 year old. The highest antimicrobial prescribing rates were in haematology and oncology wards (76% [95/125]) and paediatric intensive care units (55% [44/80]). Of 1174 antimicrobial prescriptions, 550 (47%) were for community-acquired infections, 175 (15%) were for hospital-acquired infections and 437 (37%) were for prophylaxis. Empirical treatment accounted for 72% of antimicrobial prescriptions for community-acquired infections and 58% for hospital-acquired infections (395 and 102 prescriptions, respectively). A total of 915 prescriptions (78%) were for antibacterials; antifungals and antivirals were predominantly used for prophylaxis. The most commonly prescribed antibacterials were narrow-spectrum penicillins (18% [164 prescriptions]),beta-lactam-beta-lactamase inhibitor combinations (15% [136]) and aminoglycosides (14% [128]). Overall, 957 prescriptions (82%) were deemed appropriate, but this varied between hospitals (range, 66% [74/112]) to 95% [165/174]) and specialties (range, 65% [122/187] to 94% [204/217]). Among surgical patients, 65 of 187 antimicrobial prescriptions (35%) were deemed inappropriate, and a common reason for this was excessive prophylaxis duration. %26lt;br%26gt;Conclusion: A point prevalence survey is a useful cross-sectional method for quantifying antimicrobial use in paediatric populations. The value is significantly augmented by adding assessment of prescribing quality.

• 出版日期2014-12-15