title: Antibiotic surveillance on a paediatric intensive care unit: easy attainable strategy at low costs and resources.
abstract: BACKGROUND
  Antibiotic surveillance is mandatory to optimise antibiotic therapy. Our objectives were to evaluate antibiotic use in our pediatric intensive care unit (PICU) and to implement a simple achievable intervention aimed at improving antibiotic therapy.
  
  
  METHODS
  Prospective, 3 months surveillance of antibiotic use on PICU (phase I) and evaluation according to the CDC 12-step campaign with development of an attainable intervention. 3 months surveillance (phase II) after implementation of intervention with comparison of antibiotic use.
  
  
  RESULTS
  Appropriate antibiotic use for culture-negative infection-like symptoms and targeted therapy for proven infections were the main areas for potential improvement. The intervention was a mandatory checklist requiring indication and recording likelihood of infection at start of antibiotic therapy and a review of the continuing need for therapy at 48 h and 5 days, reasons for continuation and possible target pathogen. The percentage of appropriate empiric antibiotic therapy courses for culture-negative infection-like symptoms increased from 18% (10/53) to 74% (42/57; p<0.0001), duration of therapy <3 days increased from 18% (10/53) to 35% (20/57; p=0.05) and correct targeting of pathogen increased from 58% (7/12) to 83% (20/24; p=0.21).
  
  
  CONCLUSIONS
  Antibiotic surveillance using the CDC 12-step campaign can help to evaluate institutional antibiotic therapy. Development of an attainable intervention using a checklist can show improved antibiotic use with minimal expense.
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland. stockermartin@mail.com
authors.forename: Martin
authors.initials: M
authors.lastname: Stocker
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ferrao
authors.forename: Winston
authors.initials: W
authors.lastname: Banya
authors.forename: Jamie
authors.initials: J
authors.lastname: Cheong
authors.forename: Duncan
authors.initials: D
authors.lastname: Macrae
authors.forename: Anke
authors.initials: A
authors.lastname: Furck
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D057189:Checklist / Q000191:economics; D002648:Child; D002675:Child, Preschool; D017723:Drug Utilization Review / Q000191:economics / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D008131:London; D008297:Male; D008485:Medical Audit / Q000191:economics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents