Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital – neue Wege der pädiatrischen Infektiologie

Zusammenfassung

Hintergrund:

Der zunehmende Anteil multiresistenter Erreger ist eines der zentralen Probleme der modernen Medizin. Antibiotic-Stewardship-(ABS-)Programme sind wichtige Hilfsmittel, um den Antibiotikaverbrauch einzuschränken und damit der Resistenzentwicklung entgegenzuwirken. Eine zunehmende Anzahl von Kinderkliniken sind dabei, ABS-Programme zu etablieren, wobei international bisher nur wenige Daten bezüglich der Implementierung und Effektivität dieser Programme im Bereich der Pädiatrie vorliegen.

Methoden:

Das Dr. von Haunersche Kinderspital ist eine Kinderklinik der Maximalversorgung mit allen notwendigen Fachabteilungen. Ein ABS-Programm wurde etabliert, wobei die Kernmaßnahmen der Inneren Medizin übernommen wurden. Die spezifischen antimikrobiellen Substanzen sowie die entsprechenden klinischen Endpunkte wurden an die Situation der Pädiatrie angepasst. Kernmaßnahmen waren 1. ein „pro­spektives Audit mit Feedback – nach Verordnung“ sowie 2. eine „Restriktion und Freigabe – vor Verordnung“. Das ABS-Team besteht aus einem pädiatrischen Infektiologen, einer Assistentin in der Weiterbildung sowie einer Apothekerin mit infektiologischer Erfahrung.

Resultate:

Durch die Implementierung eines pädiatrischen ABS-Programms konnte der Verbrauch antimikrobieller Substanzen in unserer Klinik signifikant gesenkt werden. Die erwarteten Kosteneinsparungen werden ca. 330 000 € pro Jahr betragen; zudem konnte der Verbrauch von Breitspektrumantibiotika, Glykopeptiden und Antimykotika signifikant reduziert werden.

Zusammenfassung:

Antibiotic-Stewardship-(ABS-)Programme können effektive Maßnahmen sein, um den Antibiotikaverbrauch einzuschränken. Nationale Guidelines sollten für die Pädiatrie in Deutschland von den Fachgesellschaften erarbeitet werden.

Abstract

Background:

The steady increase in antimicrobial resistance is of growing concern in healthcare. Antibiotic Stewardship [ABS] Strategies are important tools to control antibiotic use and ­prevent antimicrobial resistance. An increasing number of institutions are developing ABS initiatives also in pediatrics. However, few data are available assessing the implementation and efficiency of these pediatric ABS programs.

Methods:

At the Dr. von Hauner Children’s Hospital, Ludwig-Maximilian University, a ter­tiary care pediatric reference center, a pediatric ABS Team has been implemented. Key structural elements were the same as for adult patients, but antimicrobials agents selected for monitoring and appropriate clinical endpoints are different in pediatrics.

Key features were: 1. prospective-audit with feedback and formulary restriction and 2. pre-authorization (also referred to as prior approval). The ABS team consisted of one pediatric infectious disease specialist, one clinical fellow in pediatric infectious diseases, and one clinical pharmacist with training in infectious diseases.

Results:

With the implementation of a pedia­tric ABS strategy we could significantly influence antimicrobial consumption in our hospital. Cost-savings are estimated to be above 330 000 € per year, and concomitantly the use of broad-spectrum antibiotics and antifungal compounds was significantly reduced.

Conclusion:

Antibiotic Stewardship [ABS] Strategies may be an effective tool to control antibiotic use in the setting of a large tertiary pediatric teaching hospital. A national guideline for ABS initiatives may help to further improve rational use of antibiotics in the hospital setting.

Schlüsselwörter

Antibiotikaverbrauch - ABS-Programme - Pädiatrie - Verordnungsstrategien

Key words

antibiotic stewardship - ABS initiatives - pediatric medicine - hospital epidemiology

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