[Factors influencing the use of systemic antibiotics in hospitalized pediatric patients in Bucharest, Romania].
BACKGROUND
Formulation of effective strategies for prudent usage of antibacterial agents involves knowing of the factors that are modulating the variability of usage rate.


OBJECTIVE
analysis of the factors what modulate the usage rate's variability of antimicrobials prescribed to hospitalized children from Bucharest municipality.


METHODS
A statistically representative sample (n=895) has been extracted from the cohort of children discharged during October 2008 from the Bucharest's main pediatric university clinic. Demographic, clinic and pharmacological relevant data, captured by reviewing the subjects' medical charts were entered in an Epi Info database. For each enrolled subject the density rate of antimicrobial consumption has been calculated by dividing the pooled number of hospital days in which the subject received at least one dose of each individual antimicrobial agent, by the number of days of hospitalization. For the analysis of antimicrobials usage rate's variability, a rate higher the value calculated at 75 percentile has been defined as overuse. Personal, clinical and prescription characteristics significantly associated, in univariate analysis, with overuse status, were analyzed lately for independent association, by unconditional logistic regression.


RESULTS
to the sample's subjects up to 31 individual antimicrobials owning to the J01 group (antimicrobials for systemic use) of the ATC (Anatomical Therapeutic Chemical) classification promoted by World Health Organization were prescribed. In total, in the sample a number of 2607 days of antimicrobial therapy was cumulated, in 60% of these 5 antimicrobials agents were administered: ceftriaxone, gentamicine, cefoperazone, cefazolin and cefuroxime. Antimicrobials overuse was observed in 37% of subjects. By univariate analysis the overuse was significantly associated (p < 0,05) with the following characteristics of the subjects: age under one, with a trip in ICU, diagnosed with LRTI, with a hospitalization longer than 5 days, exposed to more than two antimicrobials agents during the same hospitalization episode and treated with 3rd generation cephalosporins. However, by multivariate analysis, only factors related to antimicrobials prescribing style remained independently associated with overuse status.


CONCLUSIONS
In children hospitalized in Bucharest, the antimicrobial agents' consumption is modulated by factors which are specific for this category of patients, factors broadly internationally recognized. Particularly, through multivariate analysis, we found that the factors related with antimicrobials prescription's style explained with the most fidelity the variation of usage density rate in the child hospitalized in Bucharest. The analysis of the modulators of the usage rate's variability is essential for issuing and evaluation of effective interventions focused on antimicrobials' prudent use.
Ion-Nedelcu
Niculae
N
Direcţia de Sănătate Publică a Municipiului Bucureşti.
Ulmeanu
Coriolan
C
Craciun
Maria Dorina
MD
Popescu
Ileana
I
Vieru
Florina
F
D000293:Adolescent; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002437:Cefazolin / Q000008:administration & dosage; D002438:Cefoperazone / Q000008:administration & dosage; D002443:Ceftriaxone / Q000008:administration & dosage; D002444:Cefuroxime / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D012494:Sampling Studies; D014600:Utilization Review
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002443:Ceftriaxone; D002438:Cefoperazone; D002437:Cefazolin; D002444:Cefuroxime