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Combined influence of practice guidelines and prospective audit and feedback stewardship on antimicrobial treatment of community-acquired pneumonia and empyema in children: 2012 to 2016
Authors:Nicole M A Le Saux,Jennifer Bowes,Isabelle Viel-Th  riault,Nisha Thampi,Julie Blackburn,Melanie Buba,Mary-Ann Harrison,Nick Barrowman
Affiliation:1. Division of Infectious Diseases, Children’s Hospital of Eastern Ontario, Ottawa, Ontario;2. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario;3. Service d’Infectiologie, Département de Pédiatrie, Centre hospitalier université Laval et Centre mère-enfant Soleil, Québec, Québec;4. Services de microbiologie et de maladies infectieuses, CHU Sainte-Justine, Montréal, Québec
Abstract:BackgroundAminopenicillins are recommended empiric therapy for community-acquired pneumonia (CAP). The aim of the study was to assess treatment over a 5-year period after CAP guideline publication and introduction of an antimicrobial stewardship program (ASP).MethodsUsing ICD-10 discharge codes for pneumonia, children less than 18 years admitted to the Children’s Hospital of Eastern Ontario January 1, 2012 and December 31, 2016 were identified. Children ≥ 2 months with consolidation were included. One day of therapy (DOT) was one or more doses of an antimicrobial given for 1 day.ResultsOf 1,707 patients identified, 713 met inclusion criteria. Eighteen (2.5%) had bacteria identified by culture and 79 of 265 (29.8%) had Mycoplasma pneumoniae detected. Mean DOT/1,000 patient days of aminopenicillins/penicillin (AAP) increased by 18.1% per year (95% confidence interval [CI] −0.2, 39.9%) and decreased by 37.6% per year (95% CI −56.1, −11.3%) for second- and third-generation cephalosporins in the post-ASP period. The duration of discharge antimicrobials decreased. Of 74 (10.4%) patients who had pleural fluid drained, 35 (47.3%) received more than 5 days of AAP and ≤ 5 days of second-/third-generation cephalosporins with no difference in median length of stay nor mean duration of antimicrobials.ConclusionsImplementation of CAP management guidelines followed by prospective audit and feedback stewardship was associated with a sustained decrease in the use of broad-spectrum antibiotics in childhood CAP. Use of AAP should also be strongly considered in patients with effusions (even if no pathogen is identified), as clinical outcome appears similar to patients treated with broad-spectrum antimicrobials.
Keywords:Aminopenicillin   Antibiotic use   Antimicrobial stewardship   Cephalosporin   Community-acquired pneumonia   Days of therapy
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