Abstract
Objective This study's objective was to assess an antibiotic stewardship intervention, compare
pediatric antibiotic usage in a non-university hospital (Children's Hospital Traunstein
[TS]) with a university hospital (Dr. von Hauner Children's Hospital, Ludwig Maximilians
University Munich [MUC]), and assess adherence to national guidelines.
Methods Antibiotic usage pre- and post-antibiotic stewardship (ABS) intervention was compared,
and antibiotic prescriptions over 4 months were prospectively recorded. ABS intervention
consisted of weekly teaching sessions, antibiotic pocket cards, and rounds with pediatric
infectious disease staff. Medical records were reviewed to describe antibiotic consumption,
antibiotic dosages and length of use, and adherence to national guidelines. Pediatric
antibiotic usage was compared between hospitals and patient groups.
Results After the ABS intervention, the use of second-generation cephalosporins decreased,
while penicillin with β-lactamase inhibitors (BLI) increased. Survey of antibiotic
prescriptions over the 4 months study period in the non-university hospital showed
a high administration rate of second-generation cephalosporins and extended-spectrum
penicillins in the non-intensive care units (ICU) wards (48.53 and 38.93 days of therapy
[DoT]/1,000 patient days [PD], respectively) and a high rate of third-generation cephalosporins
in the ICU ward (110.33 DoT/1,000PD). A high prescriptions rate was seen in the neonatal
intensive care unit (NICU) wards (DoT/ length of therapy [LoT] ratio of 2.185). Reserve
group antibiotics were only given in the ICU. Adherence to national guidelines was
highest in the NICU and pediatric ICU wards. Striking was the relatively high rate
of incorrect usage of second-generation cephalosporins. Comparing the pediatric wards
of the non-university hospital (TS) and the university hospital (MUC), the prescription
ratio was 11.1% (TS) versus 30.6% (MUC), and DoT/1,000PD 198.9 (TS) versus 483.6 (MUC),
p = 0.02. ABS intervention changed the choice of described antibiotics, but not the
overall frequency.
Conclusion Adherence to national guidelines was highest in fields with standardized therapy
recommendations, like in the NICU. In MUC, antibiotics, in particular restricted ones,
were prescribed more frequently, probably due to higher severity of illness.
These data indicate that the usage of antibiotics and adherence to national guidelines
show a wide variety, but ABS interventions were effective in changing prescription
behavior.
Keywords
antibiotic prescription - days of therapy per 1000 patient days - defined daily dose
per 100 patient days - antibiotic stewardship
