Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review.
Anti-Bacterial Agents
/ pharmacology
Antimicrobial Stewardship
/ economics
Asia
Bacteria
/ classification
Bacterial Infections
/ drug therapy
Child
Drug Resistance, Bacterial
Europe
Global Health
Humans
Inappropriate Prescribing
/ prevention & control
Pediatrics
Prescription Drug Misuse
/ prevention & control
United States
Antibiotic stewardship
Antimicrobial stewardship
Infectious diseases
Pediatrics
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
2020
2020
Historique:
received:
05
07
2019
accepted:
26
11
2019
entrez:
9
1
2020
pubmed:
9
1
2020
medline:
14
7
2021
Statut:
epublish
Résumé
Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
Sections du résumé
Background
Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally.
Methods
MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data.
Results
Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers
Conclusions
Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
Identifiants
pubmed: 31911831
doi: 10.1186/s13756-019-0659-3
pii: 659
pmc: PMC6942341
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
3Commentaires et corrections
Type : ErratumIn
Informations de copyright
© The Author(s). 2019.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
Références
Clin Infect Dis. 2009 Jan 1;48(1):13-21
pubmed: 19025496
J Antimicrob Chemother. 2016 Apr;71(4):1106-17
pubmed: 26747104
Infect Control Hosp Epidemiol. 2012 Apr;33(4):346-53
pubmed: 22418629
J Infect Chemother. 2016 Aug;22(8):532-5
pubmed: 27263807
J Antimicrob Chemother. 2015 Feb;70(2):602-8
pubmed: 25326088
Pediatrics. 2018 Jul;142(1):
pubmed: 29925574
J Antimicrob Chemother. 2012 May;67(5):1278-86
pubmed: 22378680
Clin Infect Dis. 2006 Jan 15;42 Suppl 2:S82-9
pubmed: 16355321
J Pharm Pract. 2017 Jun;30(3):296-299
pubmed: 27044642
J Hosp Med. 2015 Jun;10(6):358-65
pubmed: 25684689
Ital J Pediatr. 2017 Nov 17;43(1):105
pubmed: 29149862
Hosp Pediatr. 2015 Oct;5(10):520-7
pubmed: 26427920
Pediatr Infect Dis J. 2016 Dec;35(12):1362-1364
pubmed: 27649364
Acta Paediatr. 2018 Oct;107(10):1805-1809
pubmed: 29723913
Infect Control Hosp Epidemiol. 2015 Jun;36(6):673-80
pubmed: 25773192
BMJ. 2009 Jul 21;339:b2700
pubmed: 19622552
Int J Infect Dis. 2017 Nov;64:69-73
pubmed: 28941633
Lancet. 2017 Aug 26;390(10097):871-881
pubmed: 28711318
Pediatrics. 2017 Jun;139(6):
pubmed: 28562258
J Eval Clin Pract. 2009 Dec;15(6):1111-7
pubmed: 20367713
Am J Emerg Med. 2015 Sep;33(9):1129-33
pubmed: 26027885
Pediatr Infect Dis J. 2011 Apr;30(4):273-8
pubmed: 21085051
Respir Med. 2011 Dec;105(12):1939-45
pubmed: 21959024
S Afr Med J. 2015 Apr 06;105(5):325
pubmed: 26242647
BMC Health Serv Res. 2018 Aug 31;18(1):676
pubmed: 30170573
Health Serv Res. 2015 Apr;50(2):489-513
pubmed: 25287670
PLoS One. 2013 Aug 06;8(8):e68419
pubmed: 23936304
Pediatrics. 2016 May;137(5):
pubmed: 27244775
Surgery. 2017 Dec;162(6):1295-1303
pubmed: 29050887
Infection. 2003 Dec;31(6):398-403
pubmed: 14735382
Clin Infect Dis. 2011 Aug;53 Suppl 1:S8-S14
pubmed: 21795728
J Am Med Inform Assoc. 2013 Mar-Apr;20(2):317-24
pubmed: 22759620
BMC Pediatr. 2010 Dec 08;10:89
pubmed: 21143869
Clin Infect Dis. 2007 Jan 15;44(2):159-77
pubmed: 17173212
Pediatrics. 2013 Apr;131(4):e1071-81
pubmed: 23478860
JAMA. 2013 Jun 12;309(22):2345-52
pubmed: 23757082
Pediatr Infect Dis J. 2018 Sep;37(9):901-907
pubmed: 29561517
Infect Control Hosp Epidemiol. 2017 Sep;38(9):1039-1047
pubmed: 28758610
Emerg Infect Dis. 2003 Apr;9(4):432-7
pubmed: 12702222
Pediatrics. 2015 Jan;135(1):33-9
pubmed: 25489018
Euro Surveill. 2008 Nov 13;13(46):
pubmed: 19021952
J Pediatric Infect Dis Soc. 2018 May 15;7(2):113-118
pubmed: 28407067
Paediatr Anaesth. 2017 Jul;27(7):702-710
pubmed: 28321988
Clin Infect Dis. 2017 May 15;64(suppl_2):S119-S126
pubmed: 28475777
J Antimicrob Chemother. 2011 Feb;66(2):443-9
pubmed: 21084362
J Pediatric Infect Dis Soc. 2019 Sep 25;8(4):310-316
pubmed: 29846666
Clin Infect Dis. 2009 Oct 15;49(8):1175-84
pubmed: 19739972
Int J Evid Based Healthc. 2015 Sep;13(3):141-6
pubmed: 26134548
Clin Pediatr (Phila). 2010 Oct;49(10):976-83
pubmed: 20724348
J Pediatric Infect Dis Soc. 2015 Dec;4(4):e127-35
pubmed: 26582880
Appl Clin Inform. 2014 Apr 09;5(2):368-87
pubmed: 25024755
Pediatr Infect Dis J. 2008 Feb;27(2):106-11
pubmed: 18174869
J Pediatr Surg. 2016 Aug;51(8):1307-11
pubmed: 26711690
J Pak Med Assoc. 2011 May;61(5):481-5
pubmed: 22204185
Appl Clin Inform. 2013 Nov 27;4(4):556-68
pubmed: 24454582
Pediatr Infect Dis J. 2007 Jul;26(7):593-9
pubmed: 17596800
Arch Dis Child. 2015 May;100(5):454-9
pubmed: 25503715
Clin Infect Dis. 2008 Sep 15;47(6):747-53
pubmed: 18680419
Eur J Pediatr. 2014 Apr;173(4):463-8
pubmed: 24221603
BMC Pediatr. 2012 Dec 21;12:196
pubmed: 23259701
Hosp Pediatr. 2017 Sep;7(9):516-522
pubmed: 28814444
Clin Microbiol Infect. 2001;7 Suppl 6:12-5
pubmed: 11990686
Pediatrics. 2012 May;129(5):e1326-33
pubmed: 22492769
Pediatr Infect Dis J. 2016 Feb;35(2):157-61
pubmed: 26517329
Clin Infect Dis. 2003 Jun 1;36(11):1433-7
pubmed: 12766839
Pediatr Infect Dis J. 2016 Oct;35(10):1104-10
pubmed: 27254036
Antimicrob Agents Chemother. 2012 Mar;56(3):1658-61
pubmed: 22155839
Pharmacotherapy. 2014 Nov;34(11):1141-50
pubmed: 25283969
J Pediatr Health Care. 2017 Mar - Apr;31(2):184-188
pubmed: 27567148
J Pediatric Infect Dis Soc. 2017 Sep 01;6(3):e36-e40
pubmed: 28903514
Pediatr Infect Dis J. 2010 Aug;29(8):707-11
pubmed: 20182398
Pediatr Infect Dis J. 2018 Feb;37(2):164-168
pubmed: 28827495
Infect Control Hosp Epidemiol. 2016 Jan;37(1):104-6
pubmed: 26424193
Eur J Clin Microbiol Infect Dis. 2001 Sep;20(9):647-50
pubmed: 11714047
Pediatr Infect Dis J. 2014 Mar;33(3):330-3
pubmed: 24168976
Clin Microbiol Infect. 2019 May;25(5):555-561
pubmed: 30472426
Pediatrics. 2010 Dec;126(6):1067-73
pubmed: 21078728
Clin Infect Dis. 2011 Jul 1;53(1):33-41
pubmed: 21653300
Expert Rev Anti Infect Ther. 2008 Oct;6(5):751-63
pubmed: 18847410
Am J Infect Control. 2015 Nov;43(11):1255-7
pubmed: 26277573
Eur J Cancer. 2009 Nov;45(16):2843-9
pubmed: 19616427
Pharm World Sci. 2008 Dec;30(6):787-93
pubmed: 18493864
Clin Pediatr (Phila). 2017 Jul;56(8):744-751
pubmed: 27872355
Crit Care Med. 2007 Jan;35(1):89-95
pubmed: 17110877
Clin Infect Dis. 2008 Sep 15;47(6):735-43
pubmed: 18694344
Acad Emerg Med. 2018 Aug;25(8):870-879
pubmed: 29513362
Pediatr Pulmonol. 2014 Jul;49(7):701-6
pubmed: 24039234
PLoS One. 2018 Feb 28;13(2):e0193581
pubmed: 29489898
Eur J Pediatr. 2018 May;177(5):741-746
pubmed: 29455368
Clin Pediatr (Phila). 2009 Jun;48(5):505-12
pubmed: 19224865
Lancet Glob Health. 2017 Dec;5(12):e1258-e1267
pubmed: 29102353
J Hosp Infect. 2007 Aug;66(4):378-84
pubmed: 17573155
J Hosp Infect. 2018 Jun;99(2):117-123
pubmed: 28807835
Ann Surg. 2015 Aug;262(2):403-8
pubmed: 25423065
Klin Padiatr. 2013 Jul;225(4):223-9
pubmed: 23852778
Clin Pediatr (Phila). 2018 Aug;57(9):1080-1085
pubmed: 29284278
Pediatr Crit Care Med. 2016 Mar;17(3):187-93
pubmed: 26669645
Clin Infect Dis. 2009 Jan 1;48(1):1-12
pubmed: 19035777
Acta Paediatr. 2015 Sep;104(9):e422-4
pubmed: 26058421
Ann Fam Med. 2008 May-Jun;6(3):206-12
pubmed: 18474882
J Pediatric Infect Dis Soc. 2012 Sep;1(3):179-86
pubmed: 26619405
Clin Infect Dis. 2017 May 15;64(10):1449-1452
pubmed: 28186533
Pediatr Infect Dis J. 2015 May;34(5):506-8
pubmed: 25379832
Pediatrics. 2012 Mar;129(3):e597-604
pubmed: 22351891
Arch Argent Pediatr. 2014 Apr;112(2):124-31
pubmed: 24584786
Pediatrics. 2011 Dec;128(6):1062-70
pubmed: 22106075
Eur J Clin Pharmacol. 2017 Sep;73(9):1141-1147
pubmed: 28593400
Pediatrics. 2008 Jan;121(1):e15-23
pubmed: 18166533
Clin Infect Dis. 2017 Oct 30;65(10):1632-1637
pubmed: 29020143
BMJ. 2009 Jul 29;339:b2885
pubmed: 19640941
Lancet Infect Dis. 2018 Mar;18(3):e99-e106
pubmed: 29102325
Infect Control Hosp Epidemiol. 2016 Aug;37(8):974-978
pubmed: 27174362
Lancet Infect Dis. 2016 Jul;16(7):847-856
pubmed: 26947617
Infect Control Hosp Epidemiol. 2017 Oct;38(10):1137-1143
pubmed: 28745260
Pediatrics. 2013 May;131(5):e1623-31
pubmed: 23589819
Surgery. 2015 Aug;158(2):413-9
pubmed: 26054317
Infection. 2017 Aug;45(4):493-504
pubmed: 28397171
Lancet Infect Dis. 2010 Mar;10(3):167-75
pubmed: 20185095
Front Public Health. 2016 May 18;4:99
pubmed: 27242991
J Antimicrob Chemother. 2007 Sep;60(3):629-37
pubmed: 17599919
Clin Infect Dis. 2014 Jan;58(2):164-9
pubmed: 24158412
J Pediatric Infect Dis Soc. 2017 Jun 01;6(2):178-186
pubmed: 27342644
Indian Pediatr. 2010 Sep;47(9):785-8
pubmed: 21048261
Cochrane Database Syst Rev. 2017 Feb 09;2:CD003543
pubmed: 28178770
J Pediatric Infect Dis Soc. 2017 Nov 24;6(4):339-345
pubmed: 28339590
Clin Infect Dis. 2014 Oct 15;59 Suppl 3:S146-53
pubmed: 25261541
Am J Perinatol. 2017 Jan;34(2):105-110
pubmed: 27285470
J Pediatric Infect Dis Soc. 2017 Sep 01;6(3):267-274
pubmed: 27543412
Clin Infect Dis. 2008 Jan 15;46(2):155-64
pubmed: 18171244
Med Princ Pract. 2017;26(4):316-320
pubmed: 28578344
PLoS One. 2013 Nov 11;8(11):e78602
pubmed: 24244325
Pediatrics. 2017 Apr;139(4):
pubmed: 28302674
Lancet Infect Dis. 2016 Oct;16(10):1178-1184
pubmed: 27452782
Ital J Pediatr. 2017 Dec 22;43(1):113
pubmed: 29273072
BMJ Open Qual. 2018 Jan 6;7(1):e000180
pubmed: 29333498
J Antimicrob Chemother. 2013 Nov;68(11):2421-3
pubmed: 24027247
Ann Thorac Med. 2017 Jan-Mar;12(1):51-54
pubmed: 28197223
Hum Resour Health. 2009 Aug 27;7:77
pubmed: 19712484
J Infect Dev Ctries. 2009 Jul 01;3(6):447-51
pubmed: 19762958
Acta Paediatr. 2018 Oct;107(10):1716-1721
pubmed: 29603353
J Pediatr Nurs. 2015 May-Jun;30(3):494-7
pubmed: 25618611
Infect Control Hosp Epidemiol. 2013 Jun;34(6):573-80
pubmed: 23651887
Trop Med Int Health. 2018 Oct;23(10):1092-1100
pubmed: 30058210
Arch Intern Med. 2003 Apr 28;163(8):972-8
pubmed: 12719208
J Healthc Qual. 2017 Jul/Aug;39(4):e59-e69
pubmed: 27811579
Int J Antimicrob Agents. 2008 May;31(5):478-83
pubmed: 18343641
Ital J Pediatr. 2019 Aug 17;45(1):103
pubmed: 31420054
Acta Paediatr. 2010 Dec;99(12):1900-2
pubmed: 20653605
J Pediatric Infect Dis Soc. 2018 May 15;7(2):e34-e36
pubmed: 28549165
J Hosp Infect. 2008 Apr;68(4):372-4
pubmed: 18353500