Abstract
BackgroundFew data are available about temporal trends of antibiotic use in hospitalized children. The aim of the current study was to investigate the pattern and trends of antibiotic use over the years 2008–2016 in the largest children’s hospital in Italy.MethodsAnnual point prevalence surveys of antibiotic use were conducted by reviewing medical charts of 0–17 year-old children hospitalized for ≥48 h. Prevalence of antibiotic use was computed by year, type of ward and indication. Trends in prevalence over time were evaluated using the Cochrane-Armitage test. Possibile determinants of antibiotic use were assessed at univariate analysis and through a logistic regression model.ResultsOut of 3015 children, 1516 (50.3%) received antibiotics, 58.1% of which for medical/surgical prophylaxis. Prevalence of antibiotic use increased from 42.0% in 2008 to 56.2% in 2016 (p = 0.001). The prevalence of patients receiving antibiotics for medical prophylaxis increased from 6.1% in 2008 to 24.2% in 2016 (p < 0.001), whereas the prevalence of patients receiving antibiotics for surgical prophylaxis significantly decreased (from 13.7 to 11.8%; p = 0.04); no significant temporal trends were found in antibiotic use for treating infections.The administration of third-generation cephalosporins for surgical and medical prophylaxis significantly decreased over time, while the proportion of antibiotics prescribed to treat infections after microbiological investigations significantly increased. Year (ORadj: 1.8 in 2016 compared to 2008, p < 0.001), age (ORadj ≥1.5 in children ≥1 year, compared to infants ≤2 months, p < 0.001), length of stay (LOS) (ORadj: 1.4 in case of LOS between 8 and 30 days compared to LOS ≤ 7 days, p < 0.001), and type of ward (ORadj: ≥1.3 in intensive-care, surgical and medical-subspecialty units compared to medical units, p < 0.001) were significantly and independently associated with antibiotic use.ConclusionsComparing prevalence rates of antibiotic use among hospitals and over time should consider differences in patient characteristics, such as age, ward of hospitalization and length of stay. Over the years, we documented an improvement in the choice of antibiotics prescribed for medical and surgical prophylaxis. However, further efforts are needed to avoid antibiotic misuse for medical prophylaxis, and to reduce the empirical use of broad spectrum antibiotics.
Highlights
Few data are available about temporal trends of antibiotic use in hospitalized children
Starting 2008, a series of actions have been undertaken to promote the appropriate use of antibiotics, namely: a) dissemination of results of annual prevalence surveys on antibiotic use by posting reports on the hospital intranet website, presenting data in hospital meetings, and discussing actions to be undertaken within the hospital infection control team; b) production and dissemination of hospital guidelines on antibiotic surgical prophylaxis, c) production and dissemination of hospital guidelines on antibiotic medical prophylaxis; d) restriction of use of third-generation cephalosporins for surgical prophylaxis
Prevalence of antibiotic use A total of 3015 pediatric inpatients were involved in point prevalence surveys conducted between 2008 and 2016
Summary
Few data are available about temporal trends of antibiotic use in hospitalized children. The aim of the current study was to investigate the pattern and trends of antibiotic use over the years 2008–2016 in the largest children’s hospital in Italy. There is a wide variability in antibiotic consumption between countries, and Italy is one of the european nations with the highest use of antibiotics, both in outpatient and inpatient settings [10]. In 2007–2008, the annual rate of outpatient antibiotic prescriptions to Italian children and adolescents was estimated around 1.0 prescriptions/person/year, being by far the highest compared to the other european countries [11]. As regards hospital antibiotic consumption, the estimated prevalence of antibiotic use in pediatric wards in Italy in 2011 was significantly higher than the mean European estimate, being 51.5% (95% CI: 44.0–59.0%) versus 35.4% (95% CI, 33.6–37.2%) [12], respectively
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