[Rational utilization of antibiotics in critically ill children].
BACKGROUND
The high risks associated with untreated infection in critically ill newborns or children lower the threshold for prescription of antibiotic treatment. Inappropriate use of antibiotic therapy promotes the emergence of resistant strains. This study had three aims: to identify sources of inappropriate antibiotic utilisation, to develop revised guidelines and to implement changes.


METHODS
An observational study was performed in a tertiary, multidisciplinary, neonatal and paediatric intensive care unit (PICU) of a university teaching hospital during a 7-month period (456 admissions). Guidelines addressing one of the identified sources of inappropriate utilisation (prophylaxis following surgery) were developed according to published evidence and implemented, and the effect on prescription patterns was assessed during a second observation period.


RESULTS
Patients received systemic antibiotics during 54.6% of all hospitalisation days. Antibiotics prescribed for suspected or proven infection were often continued 1-2 days beyond the intended duration. Prophylaxis accounted for 28% of all systemic antibiotics given, and postsurgical prophylaxis accounted for 14.6% of all exposure days. The literature search revealed little evidence to support this practice. After new guidelines were introduced with the aim of restricting surgical prophylaxis to a single dose prior to surgery, the rate of postsurgical prophylaxis dropped from 14.6 to 11.2% of all exposure days, accompanied by a significant decline in the overall exposure rate from 54.6 to 50.2% of all hospitalisation days.


CONCLUSIONS
Several sources of inappropriate antibiotic utilisation were identified. These include failure to discontinue treatment and prolonged prophylaxis after surgery. Implementation of new guidelines reduced antibiotic utilisation.
Fischer
J E
JE
Abteilung für Neonatologie und Intensivpflege, Universitäts-Kinderklinik, Zürich. joachim.fischer@kispi.unizh.ch
Ramser
M
M
Altermatt
S
S
Nadal
D
D
Waldvogel
K
K
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D002648:Child; D016638:Critical Illness; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000592:standards; D007363:Intensive Care Units, Neonatal / Q000592:standards; D017410:Practice Guidelines as Topic
D000900:Anti-Bacterial Agents